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Workers Comp Adjuster Tricks and Tactics You Need to Know About

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Workers’ compensation is a necessary safety net for employees who are injured as a result of their job. But, as experienced workers’ compensation attorneys, we have seen every shady trick that workers’ comp adjusters try to pull. This article will discuss some of the common tactics we have dealt with and how you can avoid them.

Summary of the Key Findings

  • Insurance companies employ workers’ comp adjusters to adjudicate claims.
  • They often try to get injured workers to accept a low settlement using a variety of tactics
  • An experienced lawyer can help you avoid these traps and get your full benefits

5 Types of Workers Comp Adjuster Tricks You Should Know About

Businessmen talking to each other outside

1. Communication

A workers’ comp claims adjuster may call you late at night or on a weekend when you are not ready to discuss your case.

Additionally, the adjuster may try to rush you into making a decision or give you the runaround. The goal of this tactic is to make you so frazzled or frustrated that you take the first lowball offer that comes your way.

The adjuster may be rude or even bullying to get you to accept a low settlement offer. Or, they may be very friendly and try to build a rapport to get information that they can use against you.

Frequently, the adjuster will not inform you about all of your rights. They do not have a legal obligation to do so, but it certainly is in your best interest to know all the ‌options before agreeing to any offer.

2. Medical

Workers’ comp adjusters may ask you for a blank medical treatment authorization form so they can get your complete medical records. They are looking for any kind of pre-existing condition that they can use to deny your workers’ compensation claim.

Additionally, the adjuster may try to get you to see one of their doctors for an independent medical examination [1]. However, the doctor appointed by the insurance company is almost always going to have the insurance company’s interests in mind.

Also, adjusters may try to prevent you from seeing your doctor, or they may not authorize necessary tests or treatments.

“The Federal Employees’ Compensation program provides Federal employees who sustain work-related injury or illness with benefits such as medical care, wage loss replacement, and help in returning to work.” – U.S. Department of Labor

Further, they may assign a nurse case manager to your workers’ compensation case who will be their eyes and ears in your medical treatment. The nurse case manager will report back to the adjuster and may even try to influence your treating physician.

3. Investigation

A woman holding a magnifying glass to her eye to the cameraA workers’ comp adjuster may try to access your social media accounts or email. They will be looking for anything that contradicts your claim or makes you look bad.

Additionally, the adjuster may try to get a copy of your employment file from your employer. This will give them information about any disciplinary actions you may have had at work or any performance issues.

They may hire a private investigator to follow you around and take pictures or videos of you to try and prove that you are not as injured as you claim [2].

An adjuster may pressure you to make a recorded statement early in the claim process. They will use leading questions or try to get you to agree to statements that are not in your best interest. Once they have you on record, they can use it against you in the future.

4. Money

One common tactic is to make a lowball offer early in the claim. An adjuster may also threaten to withdraw the offer if you do not agree to it immediately. This offer is usually much lower than what you are entitled to.

They may also try to get you to agree to a lump sum settlement. This may sound like a good idea, but it usually ends up being much less money than you would get if you took the settlement over time.

They may incorrectly calculate your wage loss benefits, hoping that you sign the form and lock yourself into lower payments – saving the insurance company some money.

The adjuster may send your checks late or delay paying your medical bills. Further, they may file a notice of dispute without justification just to postpone your benefits. These tactics are designed to put pressure on you to settle for less than you deserve.

5. Legal

A person working on legalWorkers’ comp adjusters may threaten to sue you for workers’ comp fraud or file a complaint with the Department of Labor to scare you away from pursuing your claim.

An adjuster may have the insurance company’s lawyers move to dismiss an injured workers’ claim. They usually do this without merit, but it can delay you from getting benefits.

The adjuster may tell you that more information is needed to process your claim or even that your case has been closed. These tactics are used to try and get you to give up on your claim.

One particularly devious trick is that the adjuster may have the insurer pay you voluntary payments without coming to a signed agreement. Then, at the end of the statute of limitations, they cut you off after it is too late for you to file a lawsuit.

9 Tips For Dealing With An Adjuster

A hand writing on paper while another hand points to it

Dealing with insurance adjusters can be a frustrating and confusing process for an injured worker. The best way to deal with an adjuster is to be prepared. Here are some tips:

1. Get a copy of the workers’ comp claim form and keep it in a safe place.

2. Make sure you understand all the documents you sign.

3. Do not give a recorded statement without talking to a lawyer first.

4. Be polite and professional when dealing with the adjuster, but do not let them take advantage of you.

5. Do not sign a medical authorization form or agree to anything without first getting advice from a lawyer.

6. Keep copies of all correspondence and documents related to your claim.

7. Pay attention to deadlines and make sure you meet them.

8. Be prepared for the adjuster’s tricks, and do not let them get the better of you.

9. Get help from an experienced workers’ compensation attorney who can protect your rights and get you the benefits you deserve.

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FAQs

What do workers’ comp claims adjusters do?

An insurance adjuster negotiates the settlement of an insurance claim. They work on behalf of the insurance company and are brought on soon after you file a claim.

What should I do if an insurance adjuster contacts me?

An injured worker should always consult with an attorney before making any statements to a claims adjuster. They may try to get you to agree to a statement that is not in your best interest.

Can the insurance adjuster deny my claim?

Workers comp claim claims adjusters may certainly try to deny your claim, but they cannot do so without justification. If you feel that your claim was denied unfairly, you should speak with an attorney.

Know What You Deserve

Workers’ comp adjusters are skilled in getting the most favorable outcome for their company. However, with the proper preparation and knowledge, you can stand up to them and get the benefits you deserve.

If you are an injured worker, one of our experienced disability attorneys can give you a free consultation to make sure you are treated fairly.


References:

1.https://www.findlaw.com/injury/accident-injury-law/independent-medical-examination.html

2.https://www.pinow.com/articles/2863/how-private-investigators-can-get-insurance-adjuster-clients

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