Workers’ comp adjusters play a crucial role in the process of evaluating and processing claims made by employees who have been injured on the job. However, it’s important to be aware that adjusters often have a financial incentive to minimize payouts and as a result, may use certain tricks to do so. The following are some shocking workers’ comp adjuster tricks that injured workers should be aware of:
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5 Shocking Workers’ Comp Adjuster Tricks
1. Delaying the Claim Process:
One of the most common workers’ comp adjuster tricks is to delay the claim process. This can be done by requesting additional documentation or medical records, which can cause delays in the claim process and make it more difficult for the injured worker to get the benefits they need. Workers’ comp adjusters may delay the claim process in a number of ways. Some common tactics include:
- Requesting additional documentation or medical records: Adjusters may request additional documentation or medical records in order to evaluate the claim. This can cause delays in the claim process as the injured worker must gather the necessary documents and provide them to the adjuster.
- Scheduling multiple medical evaluations: Adjusters may schedule multiple medical evaluations with different doctors in order to gather additional information about the injury. This can cause delays in the claim process as the injured worker must take time off work to attend the evaluations.
- Using independent medical evaluations: Adjusters may use independent medical evaluations, which can be time-consuming and can delay the claim process as the adjuster must wait for the evaluation to be completed before making a decision.
- Ordering additional diagnostic tests: Adjusters may order additional diagnostic tests, such as x-rays or MRIs, in order to gather more information about the injury. This can cause delays in the claim process as the injured worker must schedule and attend the tests.
- Requesting clarification or additional information: Adjusters may request clarification or additional information about the claim, which can cause delays in the claim process as the injured worker must provide the requested information.
2. Denying Valid Claims:
Workers’ comp adjusters may deny valid claims by stating that the injury is not work-related or that the worker has not followed proper procedures for reporting the injury. Here are some common ways adjusters may use to deny valid claims:
- Claiming the injury is not work-related: Adjusters may state that the injury is not work-related, arguing that the injury occurred outside of work or that the worker was engaging in horseplay at the time of the injury.
- Stating that proper procedures were not followed: Adjusters may state that the worker did not follow proper procedures for reporting the injury, such as notifying the employer within a certain timeframe or not seeking medical attention immediately.
- Disputing the extent of the injury: Adjusters may dispute the extent of the injury, arguing that the worker’s injuries are not as severe as they claim, or that the injury is a pre-existing condition.
- Failing to investigate the claim properly: Adjusters may fail to investigate the claim properly, not gathering all the necessary information or evidence to evaluate the claim, which can lead to denying the claim.
- Using independent medical evaluations: Adjusters may use independent medical evaluations that are not in favor of the worker to deny the claim, stating that the worker is not as injured as they claim to be.
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3. Lowballing Settlements:
Workers’ comp adjusters may offer low settlements in an attempt to resolve the claim quickly. Here are some common ways adjusters may use to lowball settlements:
- Offering a lump sum settlement: Adjusters may offer a lump sum settlement that is lower than the full amount of benefits the worker is entitled to receive. This can be done to resolve the claim quickly and avoid ongoing payments.
- Offering a settlement before all medical treatment is completed: Adjusters may offer a settlement before the worker has completed all medical treatment. This can result in the worker not receiving full compensation for the total cost of medical treatment.
- Not taking into account future medical expenses: Adjusters may not take into account future medical expenses, such as rehabilitation or surgery, which can result in the worker not receiving full compensation for their injuries.
- Not considering lost wages and lost earning capacity: Adjusters may not consider lost wages and lost earning capacity, which can result in the worker not receiving full compensation for their loss of income.
- Not considering non-economic damages: Adjusters may not consider non-economic damages, such as pain and suffering, which can result in the worker not receiving full compensation for their injuries.
4. Misrepresenting the Law:
Workers’ comp adjusters may misrepresent the law in order to deny a claim or reduce the number of benefits that are paid. Here are some common ways adjusters may use to misrepresent the law:
- Telling the worker they are not eligible for certain benefits: Adjusters may tell the worker that they are not eligible for certain benefits, such as temporary disability benefits or medical treatment, when in fact they are.
- Telling the worker that the injury is not covered under workers’ compensation: Adjusters may tell the worker that their injury is not covered under workers’ compensation, when in fact it is.
- Telling the worker that the claim must be denied because the worker did not follow proper procedures: Adjusters may tell the worker that their claim must be denied because they did not follow proper procedures for reporting the injury, when in fact the worker did.
- Telling the worker that the claim is time-barred: Adjusters may tell the worker that their claim is time-barred, when in fact the worker still has time to file a claim.
- Telling the worker that the number of benefits they are entitled to is less than it actually is: Adjusters may tell the worker that they are entitled to fewer benefits than they actually are, such as less amount of weekly benefits, less duration of benefits, or fewer reimbursement of medical expenses.
5. Pressure to Settle:
Workers’ comp adjusters may pressure injured workers to settle by stating that the claim will take a long time to process or that the settlement offer is the best that can be expected. Here are some common ways adjusters may use to pressure injured workers to settle:
- Offering a settlement before all medical treatment is completed: Adjusters may offer a settlement before the worker has completed all medical treatment, stating that the worker will not receive any more benefits after the settlement is accepted.
- Offering a low settlement: Adjusters may offer a low settlement, stating that it is the best that can be expected and that the worker will not receive more if the case goes to trial.
- Telling the worker that the case will take a long time to process: Adjusters may tell the worker that the case will take a long time to process and that the worker will not receive benefits until the case is resolved.
- Telling the worker that the case may not be successful: Adjusters may tell the worker that the case may not be successful and that the worker will not receive any benefits if the case is not successful.
- Offering a settlement without fully explaining the terms and conditions: Adjusters may offer a settlement without fully explaining the terms and conditions, such as the fact that the settlement is final and the worker will not be able to claim any more benefits in the future.
Final Thoughts
It’s important for injured workers to be aware of these common workers’ comp adjuster tricks. It is important to understand the process and to know your rights to ensure that you receive fair compensation. In some cases, it is advisable to have an attorney to help in navigating the process. It is important to have a good understanding of the law, the process, and the rights of injured workers.