Workers Comp Adjuster Tricks: What to WATCH for…
Have you recently filed a workers’ compensation claim? What do you expect from the insurance adjuster assigned to your case?
Workers compensation adjusters are trained to protect the interests of the insurance company. They use common tricks and tactics meant to deny your workers compensation benefits or pay you as little as possible.
Knowing the most common workers comp adjuster tricks ahead of time will help you avoid delays, denials, and low settlement offers. Read on to learn the top 10 tricks adjusters may use during your workers’ comp claim in New York and how an experienced workers’ compensation lawyer can help.
Understanding Workers’ Compensation Adjusters
Workers’ compensation provides injured workers with comp benefits for medical treatment and lost wages when they suffer work injuries on the job. Insurance adjusters play a key role in handling workers’ compensation claims and determining which benefits injured workers receive.
Adjusters work for insurance companies to investigate claims and decide whether to accept or deny them. Their job is to minimize the amount paid out to injured employees. Many adjusters use common tactics and tricks to reduce the compensation paid on claims.
Knowing these common adjuster tricks can help injured workers protect their rights to benefits. This guide will cover some of the frequent tricks to avoid used by workers comp adjusters to limit claims and how to respond to these questionable tactics.
What Are Some Common Workers Comp Adjuster Tricks?
You should be aware of several common workers’ comp adjuster tricks. These include:
Recorded Statements
One very common tactic used by comp adjusters is requesting a recorded statement from an injured employee soon after the accident. Many adjusters will tell the worker it is required or routine.
However, providing a recorded statement is risky, as the insurance company can use it later to deny your workers comp claim or limit benefits. Anything you say can potentially be used against you.
It’s best not to provide a recorded statement to the claims adjuster without first consulting a workers comp attorney. An experienced lawyer can talk to the adjuster first and negotiate limitations on the statement to protect your rights.
If the adjuster asks for a statement, you can respond that your workers’ comp lawyer will contact them first to discuss handling any statements.
Delay Tactics
This can involve lengthy investigations, slow responses, or frequent requests for additional information. The goal is to frustrate the claimant into accepting a lower settlement.
Common approaches adjusters use to delay claims include:
- Delaying approval for medical treatment
- Delaying payment of workers’ compensation disability benefits
- Dragging out the claims process through constant requests for new information
- Delaying reasonable settlement offers
Identifying delay tactics early is key to countering them. Consulting with an attorney helps speed up access to benefits.
Suspicion of Fraud
In some cases, the insurance adjuster may hire a private investigator to monitor the injured worker in an attempt to discredit the injury claim.
If an adjuster suspects fraud, they may:
- Request invasive personal medical records unrelated to the injury
- Conduct surveillance of the injured worker
- Hire investigators to look for evidence of fraud
Do not take accusations of fraud personally. Politely explain your injury and that you are honestly reporting it. Have your doctor document it as well. Maintaining records helps dispute any fraud claims.
Reduced Settlement Offers
Insurance adjusters receive training to reduce the value of claims when formulating settlement proposals. Common approaches include:
- Disputing the extent of disability caused by the injury
- Blaming pre-existing conditions to discount the settlement
- Claiming the injury impact is exaggerated
Discuss any settlement offers with your workers’ comp lawyer before accepting to obtain fair compensation. They can negotiate effectively on your behalf.
Medical Care Restrictions
Another frequent adjuster trick involves restricting medical care options for injured employees. This may include:
- Only approving specific doctors or networks
- Denying treatment requests from your physicians
- Requiring second opinions from insurance company doctors
Discuss treatment needs with your doctor to fight medical care restrictions and have them advocate on your behalf. Appealing care denials is also advised.
Legal Assistance
The best protection against questionable comp adjuster tricks and tactics is hiring an experienced workers comp attorney. Firms like O’Connor Law PLLC in New York can provide valuable assistance such as:
- Handling communications with adjusters
- Fighting benefit delays and denials
- Disputing reduced settlement offers
- Appealing care restrictions
Retaining legal counsel ensures you receive the maximum comp benefits and care you deserve for your injuries.
How Can an Injured Worker Avoid These Tricks?
To avoid falling victim to these adjuster tricks, consider the following:
- Hire a Workers Comp Lawyer: They can help you understand your rights and navigate the claims process.
- Don’t Provide a Recorded Statement Without Legal Advice: You can consult with a lawyer before giving any statements.
- Document Everything: Record all interactions with the adjuster, including phone calls, emails, and meetings.
- Follow All Medical Advice: Ensure you strictly follow your doctor’s treatment plan and attend all appointments. This can help prevent the adjuster from arguing that you are not seriously injured.
How Soon Will I Begin Receiving Workers Compensation Benefits?
After a work injury, you may be eager to start receiving workers’ compensation wage replacement and medical benefits. However, the adjuster may stall approving the claim using common delay tactics.
For example, the adjuster may say they need to do more investigation or are waiting for medical records. The insurance company knows making you wait can pressure you into accepting a low settlement.
Under New York workers’ compensation laws, the insurance carrier must approve or deny your claim within 18 days. An experienced attorney will hold the adjuster accountable for following proper claims-handling procedures.
How Can a Workers Comp Lawyer Help?
A workers comp lawyer or workers comp attorney can play a critical role in helping navigate the complexities of a compensation case. They understand the comp laws and common tactics that adjusters use and can provide advice on how to communicate with the adjuster.
A comp lawyer can also help file and manage your workers’ comp claim. They can ensure that all paperwork is completed accurately and on time, reducing the chances of an adjuster denying your claim due to technicalities.
Conclusion
By understanding these common workers comp adjuster tricks and how to avoid them, you can better protect your rights and ensure you receive the compensation you deserve following a work injury.