They have different titles – workers compensation adjuster, claims adjuster, insurance adjuster. No matter the official title, chances are good that you will receive a call from this person soon after your work-related accident. Don’t take the adjuster lightly. Their job is to save the insurance company money – at your expense. Below are tips to deal with the work comp claims adjuster and the insurance company before and after you file a claim.
An insurance adjuster works for the insurance company. Their job is to investigate the facts and circumstances surrounding your claim, to determine whether your injuries are covered under the Virginia Workers’ Compensation Act, and to try to negotiate a workers compensation settlement with you. They are not your friend. And they are not there to look out for your interests. They get paid to look out for the insurance company.
The workers comp adjuster doesn’t have to give you guidance on how to maximize your legal rights after a work accident. In fact, the adjuster doesn’t even have to tell you about all the Virginia workers compensation benefits to which you may be entitled – including wage loss benefits and medical care. If you have questions about your claim, you should contact an experienced workers comp lawyer immediately.
Getting the Call from the Claims Adjuster after Your Work Accident – The Recorded Statement
Usually the adjuster will you call within 48 hours of your work accident. We’ve even see them try to call injured employees who are still at the hospital. The adjuster may ask for you to give a recorded statement by phone. Sometimes the adjuster will even ask if they can come to your home or the hospital room to take a statement.
What’s the point of a recorded statement? There are several. And not all of them are good for you. When taking a recorded statement the adjuster is evaluating:
- The facts of your case and whether the accident is covered under Virginia workers compensation. Some of the adjuster’s questions may be asked with specific commission decisions in mind. The adjuster knows that if you give a specific answer to the question, then your Virginia workers compensation claim will be denied.
- Whether you are believable and would make a good witness at hearing.
- Whether you are struggling and would likely accept a low-ball settlement offer.
- To create a version of events that can be used to cross-examine you at hearing if you change your answer.
- Whether you have pre-existing conditions.
Your recorded statement can cause serious damage to your claim. Anything you say can – and will – be used against you to deny compensability, wage loss benefits, and medical treatment. The work comp adjuster is trying to find a way to deny or limit your case.
But there is good news! You do not have to give a recorded statement to the insurance adjuster. And you shouldn’t You have the right to keep silent. If the adjuster refuses to pay you benefits without a recorded statement, call a work comp attorney immediately.
The adjuster’s request for a recorded statement isn’t the only thing you should ignore. Do not sign a medical release or authorization to release medical reports that allows the workers compensation adjuster to obtain your medical records and bills. The Virginia Workers’ Compensation Commission does not require you to sign such a release unless you treated with out-of-state medical providers. The release may allow the adjuster to speak with your doctors directly – which they do no have to do – and to work on getting medical opinions that are harmful to your case.
I recommend that you reconsider giving a workers compensation recorded statement. But if you’re going to move forward, remember to only answer questions about the following:
- How long you worked for the employer before your injury;
- Your job duties with the employer;
- The date and time of the accident;
- What caused your accident;
- Every body part hurt in the accident and condition you have suffered from since; and,
- Your medical treatment since the accident.
Provide detailed answers to questions on these subjects, but do not answer questions about your family or your finances. If the adjuster knows you are struggling financially and that you are your family’s source of income, he or she may try to settle your case for just a fraction of what it is worth.
Tactics Used by Virginia Workers Compensation Adjusters to Hurt Your Claim – and Tips to Fight Back
Most insurance claims adjusters are experienced. They’ve handled hundreds of workers comp claims and have received advice from teams of defense attorneys. If you are not represented by a skilled workers compensation lawyer in Virginia, the adjuster may try to use different tactics and strategies to weaken your claim and reduce its value. Below are common tactics, along with tips to deal with the work comp adjuster:
- Telling you not to hire a workers’ compensation lawyer. Good workers compensation adjusters start out playing nice. They will make you believe they have your best interest at heart. And make sure to tell you that you do not have to hire an attorney. They may even make a settlement offer and tell you that it is more than fair. Don’t listen. The Workers’ Compensation Act is complex and has many loopholes. Trying to take on an experienced workers compensation adjuster who handles claims like yours for a living is unlikely to lead to a good result for you.
- Telling you that an attorney will take most of your settlement and benefits. This is a common myth. But it’s not true. A study found that injured employees with attorneys recovered almost three times as much money as injured employees who were unrepresented. Hiring a lawyer gives you a better chance of maximizing your claim’s value, and most attorneys won’t charge more than 20 percent of the amount you recover, so you’ll come out ahead.
- Delaying payment because they know you need the money. Adjusters are supposed to send you agreement forms and start making weekly temporary total disability payments when it is clear that your injury is covered under the Workers’ Compensation Act. They know that your family is depending on these benefits when you’re unable to work. Unfortunately some adjusters will use this against you and delay making payments to try to force you to accept a low settlement offer when you’re desperate. How can they get away with this? They know the Industrial Commission is unlikely to sanction them if they argue that they were simply holding you to your burden of proof. This allows them to wait until the Commission enters an Award Order to start paying you. That could take months.
- Providing inaccurate or incomplete award agreements. Often potential clients call me after the adjuster has sent an agreement form for their signature. In about 75% of these cases the agreement form is incorrect – to the employee’s detriment. The worst offenses are: 1) not listing every body part injured in the accident; 2) using an average weekly wage that is too low; or, 3) not providing wage loss benefits for the entire period the injured employee was out of work. Do not sign an agreement form just to make the adjuster happy. The award must list all body parts injured and provide your true average weekly wage.
- Hiring a private investigator. The claims adjuster may hire a private investigator to follow you around and take pictures or video footage. The adjuster will then show the footage to your doctor or the Commission if it indicates that you are not as disabled as alleged. The problem is that the footage can be edited so that it doesn’t show the other one hundred hours where the private investigator found nothing or the pain you were in after performing an activity.
- Failing to make wage loss payments on time. Even when the Commission has entered an award order providing you with wage loss benefits, the adjuster may start making late payments. If your wage loss check is late, you can ask the Commission to penalize the insurance company. But the Commission will only penalize the insurance company if your work comp check is more than 14 days late. The late check penalty is equal to 20 percent of the amount owed.
- Sending you to a hand-picked doctor. The adjuster will recommend that you treat with an insurance friendly doctor. Though you cannot choose your own doctor under Virginia workers’ compensation, you are entitled to a panel of physicians. Do not let the adjuster railroad you into using the doctor of her choosing. Demand a panel – then contact an experienced work comp lawyer to pick the most claimant friendly doctor on the panel.
- Telling you your case is closed. I am amazed by the number of injured employees who call me and say the adjuster told them their case is closed. Few workers’ compensation cases are permanently closed. The only cases that are closed for good are those where: (1) the injured worker waited too long to file a claim with the Commission and their claim is barred by the statute of limitations; (2) the injured worker settled their case and the Commission has approved a full and final settlement of the claim; or (3) the injured worker lost their case at hearing and has exhausted all appeals. If you are within the appeal period or statute of limitations, a workman’s comp lawyer can help you move forward with your claim.
These are just some of the many actions the workers compensation adjuster may take to make your life more difficult and to reduce the amount of money the insurance company pays on your claim.
Let a Workplace Injury Attorney Handle the Workers Compensation Adjuster
Remember, the adjuster is not your friend. Often your goals and her goals are different. You want every benefit you are owed, including medical treatment and a lump sum settlement. She wants to increase the insurance company’s profits, which means reducing how much you get. Call an experienced work comp attorney to help you deal with the workers compensation adjuster and get every penny you’re owed.