Workers Comp Claims Adjusters and You: How to Deal with Insurance Adjusters

When you are injured at work, your employer and their insurance company should immediately step in to help you get the medical care and lost wage benefits you need. A workers’ compensation claims adjuster, also known as a case manager or claims manager, is someone who helps facilitate and coordinate an injured employee’s workers’ comp claim.

The adjuster will often set up your appointments and periodically check in on your recovery process. These contacts are often through informal phone calls or emails, but they may send you formal letters as well.

While your claims adjuster can be very helpful, it is important to remember that he or she is not entirely on your side. Instead, their interest is in ensuring that both the employer and insurance company follow workers’ compensation law, while also saving as much money as possible.

What Does a Workers Compensation Claims Adjuster Do?

The workers’ compensation claims adjuster is a claims specialist that works for the insurance company. One of their most important roles is to evaluate your claim and determine how much it is going to cost the insurance company. In most situations, they are under immense pressure to decrease the cost of your claim as much as possible.

The adjuster’s job duties often include:

•  Investigating the claim, including getting your recorded statement
• Gathering information from the employer about what happened and why
• Talking to witnesses and others who may have information about the accident
• Determining whether your claim will be accepted or rejected
• Coordinating appointments with your doctors
• Approving medical care, treatment, surgeries, etc.
• Deciding how much your case is worth and discuss settlement options

Every insurance company gives their claims adjuster varying duties. However, reporting to their supervisors so the company can keep tabs on the claim is often one of their more essential roles in a workers’ comp case.

The sooner you can get back to work, the fewer workers’ compensation benefits they will have to pay you. As a result, the insurance company will be interested in ensuring you recover quickly so your life can be back to normal as much as possible. Unfortunately, that goal can sometimes lead insurance adjusters to rush injured workers back to work when they are not quite ready.

What Will a Workers Compensation Adjuster Ask Me?

A workers’ comp insurance adjuster will likely ask you:

• What were you doing right before the injury?
• How did the injury occur?
• Did anyone see what happened?
• Did you go to the doctor right away?
• What kind of medical care are you getting?
• How long does your doctor say you need to recover?

In addition to talking to the adjuster, the injured worker will often have to fill out an accident report with their employer. That report should include information about what happened and what parts of your body were injured.

You will also be asked to sign an authorization or waiver that allows the insurance company to gather your medical records. Medical records and medical bills are often one of the most critical pieces of evidence in workers’ compensation cases. Those records will usually set out what caused the injury you are experiencing and how long you will need to recover.

What is a Recorded Statement?

Most insurance adjusters will immediately ask you for a recorded statement after your work injury. A recorded statement is just as it sounds—the insurance adjuster will ask you for permission to record, and then he or she will ask you a series of questions about the accident and your injuries. The statement is generally taken over the phone.

Giving a recorded statement is not required, but most injured workers will provide it simply because the insurance company requests it.

In some situations, the insurance adjuster can twist what you are saying so that the recording makes your incident or injury sound far less severe than it actually is. The insurance company will sometimes use this recorded statement as evidence at trial or provide it to your medical providers when they give opinions about the severity of your case.

Is There Anything I Should Avoid Saying to a Claims Adjuster?

Since claims adjusters are really on the side of the workers’ compensation insurance company, you should keep in mind that he or she is not really on your side. They may be helpful, but the only person on your team after a work injury is you and your attorney.

Even simple things like responding to “How are you?” with “I’m fine,” can end up being held against you down the road. Everything you say to the insurance adjuster should be in line with what you are telling your doctors in your medical treatment.

Worried About What to Say? Speak to a Workers Compensation Attorney

Although it may not feel like it, you actually do not have to talk to the claims adjuster at all if you are uncomfortable. Your attorney can do that type of work for you. Not speaking with the insurance company ensures that you do not accidentally say something you did not mean.

At Kranso, Kranso, & Onwudinjo, we have created a resource center that you can use, including blog content and articles to help injured workers in Pennsylvania. Our law firm provides straightforward legal advice on workers’ compensation law that addresses your unique work injury.

For a free consultation, contact our firm and schedule an appointment at one of our 12 office locations in Pennsylvania.