When an employee is injured at work, they report it immediately to their employer and get the emergency care they need. After the emergency is resolved, the worker may still have ongoing medical issues or need to recover at home before returning to work.
As a result, the employer turns to their workers compensation insurance company for assistance in covering the loss of a valued worker and the expenses to help them recover. Some employers may be self-insured, but most use an insurance company to handle the claim.
Similar to a car accident, an adjuster is assigned to the case to manage the claim and help the insurance company and the employer save money and resolve the situation quickly. While these goals make sense, sometimes the needs of the injured worker are missed. To make sure your needs are not overlooked, the following is a list to guide workers through dealings with insurance adjusters.
Many injured workers must keep track of all their medical records as they go through the claims process. Similarly, a worker should maintain a log or record regarding the communication with the insurance adjuster.
Keeping this information updated and detailed can help the worker remember exactly what was promised but also serves as documentation or evidence that the adjuster agreed to something during that communication should it differ later as the claim is finalized.
Written communication is preferable and keeping a binder or electronic storage of all email correspondence and letters between the worker and the adjuster is recommended. However, if a phone call is required, keep detailed notes of the conversation and record the date and time of the call.
After an on-the-job injury, it is common for the employer to request a written summary of what happened. Afterwards, you may be asked additional questions or asked to provide more details of how the injury occurred.
The adjuster may also inquire about your past health and whether you have had accidents or injuries in the past. Their job is to investigate whether this was a work-related incident in order for the insurance company to cover the claim. Sometimes the adjuster may conclude that your present injury is related to a past accident or injury.
While you should always be truthful with the adjuster regarding these issues, it is important to think through all your answers before providing any verbal or written response to the adjuster so there is no confusion that your present injury is a result of the recent incident and not a prior one.
While you should always try to be polite, respectful and honest with the adjuster, there may be times when the adjuster fails to respond to your communications, does not update you on the status of your claim in a timely manner, or has been inappropriate.
If this happens, you should contact their supervisor. Understand that doing this may hinder further communication with the adjuster but the supervisor should make sure the adjuster continues to do their job so your claim can be properly handled.
When involving a supervisor make sure you are prepared with a detailed account of why you need their help as well as the dates and details of what the adjuster did that made you unsatisfied.
If you are having difficulty with an adjuster or the claims process has become difficult for you to manage, an employment law lawyer near you can assist. They can take over communication with the adjuster and represent you if your claim is denied.