As an employee, if you were hurt on the job, you can file a workers’ compensation claim to receive medical benefits and lost income. After you file a claim, you will be contacted by an adjuster, the person in charge of your claim. The workers’ compensation adjuster will need to speak with you about your injury to obtain information and get answers to questions.
These conversations are often recorded, and they will serve as a reference later in the case. If there are problems or discrepancies later, your conversation may be crucial in deciding your claim.
Unsure what to say and what to avoid? Continue reading to learn our tips for communicating with a workers’ compensation adjuster handling your on-the-job accident injury case.
How to Communicate with a Workers’ Compensation Adjuster
The adjuster will typically have a list of questions prepared for the interview. If you are unsure of a question, do not provide an answer until you get clarification. If you do not remember or do not know the answer, don’t speculate. It is okay to tell them you do not know.
Don’t Overthink It
Do not try to second-guess the workers’ compensation adjuster. You don’t know where the questions are leading, so it is best to answer them as truthfully as possible simply.
The most important questions will likely revolve around your medical treatment. The adjuster will try to determine whether you had an existing condition that would keep you from being awarded a workers’ compensation claim.
Seek Help from a Workers’ Compensation Advocate
It is often helpful to seek legal representation from a qualified workers’ compensation attorney. This is especially true if there are any hiccups in getting approved for medical coverage and wage loss benefits.
Your lawyer will:
- Help guide you through the process
- Advise you on how to answer questions regarding your case
- Recognize workers’ compensation adjuster tricks
- Advocate for your right to benefits
- Argue for continued care if you need it
- Support you through an appeal for a claim denial
If you’re facing any challenges or aren’t sure how to talk to your adjuster, you may want to seek guidance from an attorney to help you through the workers’ compensation process.
For a free legal consultation, call (404) 888-8888
What do You Do if Your Workers’ Compensation Benefits Stop?
Sometimes a case does not progress as it should. When some questions or problems remain unanswered, the adjuster may decide that the case is taking too long and stop your benefits. If this happens, you need help quickly. Your lawyer will determine what has caused the problem and then work to resolve the situation so that your case reaches a favorable conclusion.
Beware Low Settlement Offers
An adjuster may stop your benefits if they want to end the case more quickly. The adjuster knows that you are more likely to accept a settlement when the benefits stop, even if it is too low. Do not accept a low settlement until you talk to your attorney first. Your lawyer will try to get you the money you deserve for the injuries you suffered while on the job.
Your Rights Following a Claim Denial
In some cases, the insurer may refuse your coverage to begin with. Reasons include:
- Claims that you were injured outside of work
- Attempts to blame a third party
- Issues with your claim filing
- Waiting too long to file a claim, arousing suspicion about the injury
- Unfair claim denial without an investigation
Call a workers’ compensation attorney first if this occurs. This is the best way to find out about your options for getting approved for benefits or seeking a settlement.
An Adjuster Is Not on the Employee’s Side in a Workers’ Compensation Case
The first and most important thing to note is that a claim adjuster is not on your side, even if they appear very friendly. An adjuster works for an insurance company that is in business and wants to make profits. Their end goal is to minimize as much as possible the amount of money they pay you.
A workers’ compensation claims adjuster may not be a bad person, but their objective does not play to your advantage. Instead, their job is to pay you the lowest amount of money or even deny your claim to save the insurance company money. As a result, caution is important when dealing with an adjuster and giving them information that may jeopardize your claim.
If you consult a Georgia workers’ compensation lawyer before talking to an insurance adjuster, you can avoid common pitfalls. The attorney will analyze the facts of your case and guide you on what to answer. They can also prevent you from answering unnecessary questions during a discussion with an adjuster. They may even handle the conversation on your behalf.
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The do’s of Communicating with a Workers’ Compensation Adjuster
The first discussions about your accident and compensation claim are sometimes difficult, but you need to remain calm through the process. It is possible to hear from several insurance companies and adjusters, so make sure that the facts you give do not contradict each other.
Below are a few things that you should do when the adjuster calls you.
Note Down the Details of the Adjuster
The first step you should take before discussing anything with the insurance adjuster is to write down their information. Ask for:
- Their full name
- Name of the insurance company they work for
- Contact information
- Business name if they are an independent claim adjuster
Keep all your notes, along with the date for each, in a file folder so that you can easily find the information you need when you need it.
Give the Adjuster Limited Details of Your Personal Information
The adjuster will ask you for some personal information like your full name, address, and contact information. It is okay to give them that. However, do not go as far as to provide them with details about your work, income, or personal family information.
A workers’ compensation adjuster will have access to information about your workplace, income, and other details through other documents filed in the case. Therefore, you do not want an estimate you give to reflect a lower overall income or other inconsistencies from these documents.
Take Notes of the Conversation
Have a book and pen ready to scribble down details of the conversation between you and the adjuster. It is imperative that you do this if the adjuster says something else later, and you are unsure if that is true or false. Note the questions they ask you and, if possible, the replies you give.
Even if you are angry about the accident and the circumstances surrounding it, do not pour your anger on the claim adjuster. It will not help in winning your claim. Unfortunately, most adjusters have come across fuming claimants, and it does not always end well.
Remember that while an adjuster is not on your side, being nice may have its perks. The adjuster may expedite your compensation claim because you are friendly to them. While they work for the insurance company, they encounter many people who likely make their job unpleasant. You do not have to be one of them to protect your rights. Common courtesy goes a long way.
Ask Them Questions
A conversation is a two-way dialogue. Ask questions, like whether the adjuster is aware of any witnesses and if they can send you a copy of your employer’s first accident report. If you have not yet seen a doctor, ask for a list of the insurance company’s recommended physicians.
If you aren’t sure what questions you can ask a claims adjuster, a workers’ compensation lawyer can help you draft several questions. Asking questions not only enables you to get the necessary information but also alters the dynamic of the conversation into two people working together on a claim instead of an adjuster gathering information.
Describe Your Injuries Inclusively
When the adjuster asks about your injuries, describe them in an overly inclusive manner. You must ensure that every part that is injured is covered. If you fail to mention any area, the adjuster will happily not pay for it.
For example, you could feel leg pain only in the knee and ankle areas during your conversation with the adjuster. However, a week later, the pain spreads to your pelvic bone. In such a case, you should tell the adjuster that the injury is on your whole limb instead of giving specifics.
Tell the adjuster that you will provide them with a detailed and conclusive medical report once the doctors have completed your check-up.
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The don’ts of Communicating With a Workers’ Compensation Adjuster
As you speak to the claims adjuster, avoid doing the following. They could affect your chances of getting compensated.
Don’t Give Details of the Accident to the Adjuster
When discussing your claim with an adjuster from the worker’s compensation insurance company, politely refuse to give details of the accident. They may try to engage you in such a conversation without you knowing. Instead, just give them the general information about the accident:
- Nature of the occurrence
Tell them that you are still investigating the matter and will provide better details at the right time. Your attorney can handle this. They can also help you prepare after reviewing the accident report and other documentation of the workplace injury. In addition, they will ensure you take the necessary steps to protect your rights through this process.
Don’t Agree to an Audio Tape of Your Statement
You do not have to provide a recorded statement to the adjuster. They often request a recorded statement to get your side of the story on tape. However, this will not help your case. They have other ways of getting most of the necessary information. Your attorney can help you fill in any blanks later. A recorded statement can only work against you, allowing them to try to use your own words against you later.
Don’t Sign Any Documents Before Reviewing Them
If the claims adjuster sends you forms to sign, only do so after your lawyer has reviewed them. The most common document that an adjuster will send you is the medical authorization form. This allows them to obtain your medical records.
You are obligated by Georgia’s workers’ compensation laws to give medical authorization to an insurance company if you are making a claim and they request it. That being said, the adjuster doesn’t need access to all of your medical records. You only need to provide those that pertain to your workplace injury.
They may try to obtain additional records to try to blame your current injury on a pre-existing condition or point to other issues in your past as a reason to deny your claim. You are within your rights to only authorize access to records that relate to this injury; nothing more.
Tactics Adjusters Use to Reduce Your Claim for Workers’ Compensation
Effectively communicating with workers’ comp adjusters is about more than what you do—it’s also about what the claims adjuster does. It is essential to understand that the insurance adjuster, or your employer, may try to utilize some common tactics during the claims process that could impact your claim.
An experienced workers’ compensation attorney can help you avoid some of the pitfalls of the procedure. Working with a law firm familiar with Georgia’s workers’ compensation program and how these insurance claims work can protect your rights and help you get the medical care and wage loss benefits you need.
Refusing to Approve a Referral Physician
The authorized treating physician (ATP) is your primary doctor when you first get treatment for a work injury. Once your doctor evaluates your condition, they may find that you need to see a specialist or another doctor. This requires the insurer to approve the new doctor before they begin paying for the treatment.
In some instances, the insurance company might not approve the referral. This could delay your treatment and make the situation more complicated. However, the insurance company should not do anything that may negatively affect your medical care. A delay in treatment could cause you significantly more pain and disability and could even affect the effectiveness and outcome of your treatment.
Waiting Too Long to Approve Your Claim
According to the State Board of Workers’ Compensation, employees in Georgia are entitled to workers’ compensation benefits that cover a portion of their lost wages if they are out of work for longer than a week with a work injury.
Unfortunately, the insurance adjuster may take a long time to approve your claim in the hopes that you will simply recover and go back to work, and they will not need to make a payment. Consult with your attorney if your claim is delayed.
You are still entitled to payment for the qualifying days you missed at work, even if you returned to the job before receiving approval and pay. An attorney can help you pursue a settlement based on the benefits you did not receive but were due to you based on the facts of your comp case.
Employer Offering Light-Duty Work
Sometimes, an employer may informally tell you that they will provide you with a light-duty job if you return to work. If you do not take the offer, the insurance company may try to say that you were unreasonable and did not want to go back to work. This is a frustrating workers’ comp adjuster trick.
Despite what they say, unless the employer goes through the correct process and gets the light-duty job approved first, you are not required to accept this offer. If your benefits were terminated because you did not accept an informal offer of a light-duty job, your rights were violated, and you could have grounds for additional legal action.
Taking Recorded Statements
The insurance adjuster will speak to you to discuss the details of your accident and injury. Be aware that the statements they take are recorded. Recordings allow them to use your own words against you later in the workers’ compensation case.
For example, if you leave out some critical details, the adjuster may say that your statement is inconsistent with your injuries. Therefore, do not speak to an adjuster before talking to your workers’ compensation attorney.
Not Allowing You to Change Doctors
As the Georgia State Board of Workers’ Compensation Bill of Rights outlines, you can make one change to your primary physician or panel of physicians. You are within your rights to request a change; however, sometimes, an employer may not allow you. This is something you should immediately bring to the attention of your workers’ compensation attorney.
Get Help from a Workers’ Compensation Attorney with Your Claim Today
Workers’ compensation cases are often very complicated. Even those that seem straightforward can become complex and difficult to resolve. Therefore, you need help from an experienced workers’ compensation lawyer. Your attorney understands how to resolve even the most complex cases favorably. Sometimes there is a simple fix to your situation that your lawyer will facilitate.
Remember that the adjuster works for the insurance company and therefore wants to provide the lowest compensation possible. A lawyer will ensure that your rights are protected regardless of the complexity. They will answer your questions and guide you through the entire process. Contact the compassionate legal team at Bader Scott Injury Lawyers to get more tips for communicating with a workers’ compensation adjuster. Call to discuss the details of your case today.
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