Dealing with Your Employer's Insurance Company and Your Claims Adjuster

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Do I Have an Insurance Company and Claims Adjuster?

The majority of employers hire an insurance company to provide them with worker's compensation insurance for their employees and to handle any claims. Unless your employer self-insurers, your benefits will be managed by a claims adjuster at the insurance company. It is important to remember that the claims adjuster and insurance company represent your employer. Ultimately, their goal is to settle your claim quickly and inexpensively. 

That said, an injured worker should develop a working relationship with an adjuster to make sure that his or her rights are represented. Below is a general guide to help you work effectively with your employer’s insurance company and claims adjuster.

1. Keep a Record of Communications with the Insurance Company

An injured worker should keep a file of all correspondence to and from the employer's insurance company. If you choose to communicate by phone, be sure to take notes of what was discussed in the conversation. By doing this, discrepancies between the adjuster's version of the conversation and your own will be less likely to be resolved in favor of the insurance company and against you. Also, if your adjuster promised to do something for your claim, you will have a written record to support your assertions.

2. Be Thoughtful When Answering Questions

Part of the claims adjuster's job is to make sure that the claimed injury is truly work-related. You may be asked questions whose answers could be manipulated to reach the conclusion that your injury is not work-related. If you are asked about activities outside of your job or prior injuries, you must answer them honestly, but do not hesitate to reinforce that your present injury was caused by your job. Also, make sure to think carefully about a written statement that you are asked to make before you make it.

3. Contacting your Adjuster's Supervisor

Even if you have a professional relationship with your adjuster, there may be a time when you need to speak with a supervisor. Be aware that going above your adjuster's head could have a negative effect on your relationship and make it difficult to communicate effectively in the future. But if your adjuster has behaved unreasonably or is not responding in a timely manner to your claim, you are more likely to have your requests met by speaking with your adjuster's supervisor. Before contacting a supervisor, be sure that your requests are reasonable and that you can calmly and clearly explain them without complaining about what you think your adjuster did wrong.

4. Contact a Lawyer

You should contact a lawyer if the claims adjuster assigned to your case is habitually unresponsive or if you are unable to communicate effectively with the adjuster. Once you hire an attorney to represent you, your attorney will communicate with your employer's insurance company on your behalf. You should speak with a lawyer if the claims adjuster assigned to your case is habitually unresponsive or if you are unable to communicate effectively with the adjuster. An attorney will also be able to help you if the insurance company says that you are not entitled to worker's compensation benefits.

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Last Modified: 03-17-2014 09:37 AM PDT

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