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

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When an employee suffers an on-the-job injury at their workplace, the first step is to report that injury to their employer and then seek the care that they need as a result of the injury. Then, after the injury has been treated, that worker may also have ongoing medical issues or need to recover for a period of time before they are able to return to the workplace.

Because workplace injuries often occur, an employer will typically work with a workers’ compensation insurance company to assist their company in covering the injured worker’s expenses, such as medical bills and lost wages.

A workplace injury is an injury that occurs during a person’s employment and is caused by the type of task that they are required to do at their job. However, workplace injury can also apply to injuries that occur during work hours while not on-the-job or while simply on the employment premises.

What Injuries Are Covered by Workers’ Compensation?

Although some employers may compensate employees for injuries that are not associated with their job description, most workplace injury claims focus on injuries that are directly associated with an employee’s job description. Common examples of workplace injuries that may be covered by workers’ compensation include, but are not limited to:

  • Repetitive stress injuries, such as carpal tunnel syndrome or tennis elbow, which are further discussed below;
  • Respiratory illnesses, such as those resulting from inhaling toxic substances;
  • Various industrial diseases, such as popcorn lung;
  • Injuries resulting from being in a confined space for extended amounts of time;
  • Slip and fall injuries.

It is important to note that there are certain situations in which workers’ compensation may also cover off-site injuries that are sustained outside of an employee’s workplace. For example, injuries resulting from a car accident that occurred during working hours may be covered by an employer’s workers’ compensation insurance company.

However, this will largely depend on the nature of the employment contract between the worker and employer, as well as individual state laws. In general, if an injury occurs while a worker is on the clock or is under the direction of their employer, then it is often possible to hold an employer liable for those injuries.

These matters are often handled similarly to a car accident. This means that an adjuster will be assigned to the case to manage the claim brought by the employer on behalf of the employee and help the insurance company and the employer save money and resolve the situation quickly.

Although the stated goals make sense for the employer and insurance company, sometimes the needs of the injured worker are missed. As such, in order to make sure your needs are not overlooked, the below sections are a guide to assist you in dealing with your workers’ compensation insurance adjusters.

Communication Log or Record

When dealing with an insurance adjuster, it is important for an injured employee to keep track of all their medical records as they go through the claims process. It is also important for a worker to maintain a log or record regarding any communications with their insurance adjuster.

Keeping an updated and detailed communication log or record can help the injured worker remember exactly what was promised to them, as well as serve as documentation or evidence that the adjuster agreed to something during their communication with the injured worker. This is especially important should the adjustor’s communication or the insurance company’s actions differ later as the injured worker’s claim is finalized.

It is preferable to keep all communication logs or records in a written or electronically secure form. This means that any email communications or letters sent by the insurance adjustor should be kept in a binder or saved in a secure electronic folder. If a phone call occurs between the injured worker and adjustor, and the worker is unable to record the conversation, it is important to keep detailed notes of the conversation and record the date and time the call was made.

Statements to the Adjuster

After a workplace injury occurs, it is common for the employer to request a written summary of what happened from the employee and witnesses to the incident. Afterward, an injured employee may be asked additional questions or asked to provide more details of how their injury occurred.

Additionally, an insurance adjuster may also inquire about an employee’s past health issues and whether or not they have had accidents or injuries in the past. This is because an insurance adjuster’s job is to investigate whether or not the incident that occurred was a work-related incident. If it was not a qualifying workplace incident, then the insurance company may not cover the employee’s injuries or deny their claim.

Further, an adjuster may sometimes conclude that the injured employee’s present injury is related to a past accident or injury and deny their claim or not cover their complete damages.

It is important to be truthful with the adjuster regarding the above questions and issues, but it is also important to think through all your answers before providing any verbal or written response to the adjuster. This is important in order to ensure that there is no confusion that your present injury is a result of a workplace injury and not a prior injury.

What to Do if You Have a Problem With Your Adjuster?

There may be times in which an insurance adjuster fails to respond to an injured worker’s communications or does not update the injured worker on the status of their claim in a timely manner. Further, there are many situations in which the outcome of the workers’ compensation claim is insufficient for the injured worker, as it does not cover their hospital expenses or lost wages.

In these cases, it is important to first try and go through the insurance company, such as by contacting the supervisor on the claim. However, doing so may hinder further communication with the adjuster or slow down the handling of the claim. If this still does not resolve your issues, then you should consider speaking with a workplace injury lawyer who is familiar with employment regulations and laws.

Additionally, you should always consult a medical professional in order to discuss the extent of your injuries, as well as the recovery process for those injuries. It is important to note that your personal safety and health should never be compromised by your employment.

How Long Does It Take for an Adjuster to Make a Decision?

In general, the workers’ compensation system is designed to streamline the process for injured workers to get compensated for their on-the-job injuries. However, one of the major complaints by injured workers is that their workers’ compensation claims take too long to resolve. In fact, there are numerous studies and surveys that have shown that the average workers’ compensation claim takes more than 12 months to resolve.

However, this does not mean that an injured employee will not have their hospital expenses or lost wages covered while their workers’ compensation claim is pending. In fact, injured employees often receive temporary disability payments to replace part of their lost wages.

Do You Need a Lawyer?

If you are experiencing a workplace injury, it is in your best interests to consult with an experienced and local workers’ compensation lawyer. An experienced workers’ compensation attorney can help you understand your legal rights and options according to your state’s specific workers’ compensation laws. Additionally, an attorney will also be able to represent you in court as needed.

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