Have you ever been injured on the job? If so, you may be familiar with the workers’ compensation process and the role of a workers’ comp adjuster. But the workers’ comp adjuster is here to help you right, or do they have their own interests in mind?
In this article, we will delve into the role of a workers’ comp adjuster and explore whether they are truly on your side. We will discuss their responsibilities, potential biases, and offer some tips for navigating the workers’ compensation process effectively.
Will the Adjuster Help You Through Your Case?
Absolutely not. The adjuster has only one job: to make their company profitable. The way they do that is by limiting how much they spend on your case. This doesn’t mean they’re going to be hateful and evil to you. Although some may take this route, it is far more likely that they’ll be pleasant but won’t follow through with things that cost their company money. Things like mileage reimbursements, prompt scheduling of medical appointments, and ensuring that your weekly checks included credits for overtime, bonuses, and per diems.
What about the adjuster hiring a rehabilitation nurse? Our impression is that this is a calculated maneuver on their part. Yes, the nurse costs money. But if the nurse is effective the doctor may order less treatment and return you to work sooner than they ordinarily would. All of that saves the adjuster money.
Keep in mind that your adjuster is probably under pressure from their supervisors to close out files as quickly as practicable. They’re also probably getting an earful from a lot of injured workers. If they’ve been around any length of time, they may well be feeling a little burnt out or jaded as to the complaints of workers’ compensation claimants.
The other thing to understand is that your adjuster is a professional. They know the ins and outs of workers’ compensation. They undergo rigorous annual training and periodic updates on the law. They are professionals. You are probably very good at what you do (or did). But you aren’t a workers’ compensation professional. Putting it bluntly: you’re no match for them. You won’t even necessarily know where’s they’re cutting you short if they do. And this is without them even turning to a defense attorney to assist.
The bottom line is that workers’ compensation is one of those areas where you can be underwater without even knowing you are. That’s how complex the law is. It is never ever a mistake to call a lawyer. You may not need to hire one. But you do need to speak with one.
What are the Common Challenges in Dealing with a Workers’ Comp Adjuster?
Dealing with a workers’ comp adjuster can be a challenging and sometimes frustrating experience. While their role is to assist and facilitate the workers’ compensation process, there are several common challenges that individuals may encounter.
One of the main challenges is the adjuster’s workload. Workers’ comp adjusters often handle multiple cases simultaneously, which can result in delays in communication and processing. It is not uncommon for adjusters to be overwhelmed with paperwork and administrative tasks, leading to slower response times and potential frustration for the injured worker.
Another challenge is the adjuster’s loyalty to the insurance company. Although adjusters are supposed to be impartial and fair, their primary responsibility is to protect the interests of the insurance company. This can sometimes lead to disputes over the extent of injuries, the need for medical treatments, or the approval of certain benefits.
Furthermore, the complexity of workers’ compensation laws and regulations can pose a challenge. Adjusters are well-versed in these laws, but injured workers may struggle to understand their rights and entitlements. This knowledge gap can create a power imbalance during negotiations and make it difficult for workers to navigate the system effectively.
Additionally, some adjusters may exhibit a lack of empathy or understanding towards the injured worker’s situation. This can lead to a breakdown in communication and a sense of mistrust. It is crucial for injured workers to advocate for themselves and seek legal representation if necessary to ensure their rights are protected.
How Do You Advocate for Yourself While Working with a Workers’ Comp Adjuster?
When dealing with a workers’ comp adjuster, it’s important to remember that their primary goal is to protect the interests of the insurance company. While they may provide assistance and guidance throughout the claims process, it’s essential to advocate for yourself to ensure you receive the benefits you are entitled to. Here are some steps you can take to advocate for yourself while working with a workers’ comp adjuster:
1. Educate Yourself
Take the time to understand your rights and responsibilities under workers’ compensation laws. Familiarize yourself with the specific guidelines and deadlines in your state. This knowledge will empower you to ask the right questions and make informed decisions.
2. Document Everything
Keep a detailed record of all communication, including phone calls, emails, and letters, with the adjuster. Note the date, time, and content of each interaction. This documentation will serve as evidence in case of any disputes or misunderstandings.
3. Be Prepared
Before speaking with the adjuster, gather all relevant documents, such as medical records, accident reports, and witness statements. Having this information readily available will help you provide accurate and consistent information throughout the claims process.
4. Communicate Clearly
When discussing your case with the adjuster, be concise, honest, and assertive. Clearly explain your injuries, symptoms, and limitations. Share how your injuries have affected your ability to work and carry out daily activities. It’s crucial to be consistent in your communication to avoid any potential discrepancies.
5. Seek Legal Advice
If your workers’ comp claim becomes complex or if you encounter any difficulties with the adjuster, it may be beneficial to consult with an experienced workers’ compensation attorney. They can provide guidance, protect your rights, and negotiate on your behalf to ensure you receive appropriate benefits.
