A workers’ compensation adjuster’s job is to investigate claims, gather evidence, and determine the extent of the insurance company’s liability. However, there are some workers’ comp adjuster tricks insurance companies take advantage of to deny claims or limit payouts.
If you suffer a work-related injury and are struggling to secure your workers’ comp benefits, be aware of these top 10 tricks.
Top 10 Workers’ Comp Adjuster Tricks that Can Hurt Your Case
Protect yourself from these adjuster tricks so your claim won’t be rejected while maximizing your payouts. The tactics below are technically legal, but may hamper your ability to receive payouts if carried out effectively.
1. Asking for a Recorded Statement
You should never agree to give a recorded statement to a workers’ comp adjuster. Instead, always speak with an experienced workers’ comp attorney beforehand. Insurance adjusters ask for a recorded statement to gather missing information or avoid misinterpretation.
Nevertheless, they are experienced in asking leading questions designed to make you lower your guard. You could misspeak or misinterpret something, which the insurance company could then use to question your credibility. This tactic may reduce or even deny your workers’ comp benefits.
2. Pushing You to Sign a Medical Records Release Form
Insurance companies are entitled to review your medical records and verify whether your injury is legitimately work-related. They may insist you give them full access to your medical history by signing a medical records release form (HIPAA).
You may believe this is to help you secure your workers’ comp benefits, but really, they’re looking for these two things:
- Permission to speak directly with your doctors. The adjuster can only reach your doctor if you authorize a blanket HIPAA release. They may try to influence your doctor’s recommendation — like having you return to work before you’re ready.
- Pre-existing conditions. An adjuster with access to your medical history can dig around for past medical issues. Then, they can suggest your injury was affected by external factors unrelated to your job. This is one of the most common workers’ comp adjuster tricks for denying people benefits.
3. Offering a Quick, Lowball Settlement Offer
A workers’ comp adjuster knows you’re suffering, so they use this to their advantage. Your medical bills are piling up, and you’re in no condition to work. You’ll have lost wages and bills to pay. Sometimes insurance adjusters use this as leverage to settle your compensation claim for less than what it’s worth.
Never agree to the first quick settlement offer. Instead, speak with an attorney specializing in workers’ comp for free about your situation. A lawyer can always negotiate a higher settlement offer to make sure you get all the compensation your injury’s worth. Since most insurance companies offer to settle for less than your total expenses, legal representation can maximize your compensation offer.
Unfortunately, once you agree to an unfair settlement, it’s almost impossible to get more money after that. Thus, it’s better to wait it out and receive a fair settlement than to grab the unfair deal offer right away.
4. Hiring a Private Investigator to Watch You
It’s not illegal nor uncommon for insurers to hire private investigators to watch you after you file for workers’ comp. Claims adjusters often use this tactic to try and catch you doing anything that makes it seem as though you’re exaggerating or faking your injury.
Luckily, you can take steps to protect yourself from shady workers’ comp adjuster tricks like this one. Even when the insurance company doesn’t dispute your claim, make all your activities consistent. Don’t put yourself in situations that make you seem stronger than you really are and healthy enough to work.
For instance, if you broke your arm in a fall at work, don’t lift heavy boxes or mow your yard. You may not realize it, but those types of photos or videos can easily jeopardize your workers’ comp case.
Keep in mind private investigators carry cameras that can capture images from over a hundred feet away. Even if you don’t see anyone, they can still hide nearby and take pictures that could hurt your case.
Another tip to remember is if you’re active on social media and often post photos of yourself. Always observe what you post and ask yourself: Could someone use this out-of-context picture to damage my workers’ comp case?
Here’s one example: You have a back injury and post yourself at an amusement park as if you were going for a ride. Even if all you did that day was walk around eating ice cream, the photos may tell a different story.
5. Allowing You to Speculate, Guess, and Give Opinions
Although you refused to give a recorded statement, insurance adjusters can still make conversation looking for loopholes in your case. For instance, they can try to catch you saying something that contradicts what you stated earlier or in a video. They could also suggest your injury came from a past incident or illness or that it isn’t work-related.
You might not remember your earlier conversations or the exact order of events. You’ll probably misspeak or contradict yourself on accident without intentionally being dishonest. However, these slight mistakes could be enough for the adjuster to dismiss your workers’ comp case. Keeping your answers short and to the point can help you avoid these types of shady workers’ comp adjuster tricks. Don’t offer more information than is necessary when speaking with the claims adjuster.
A workers’ comp attorney communicating on your behalf with the insurer can prevent you from putting your case at risk.
6. Delaying Your Compensation for as Long as Possible
Unfortunately, there can be delays in settling workers’ comp cases. Then, either your employer or claims adjuster sends a ‘Notice of Delay in Determining Liability for Workers’ Compensation Benefits’ letter. The notice will inform you that before the insurer can approve or deny your claim, they must conduct an investigation.
Here’s an example of when such a delay might backfire against the insurer. If the insurer takes more than 90 days to process your claim, California law says they must automatically approve it. However, the insurer can also file for a 90-day extension to investigate your claim. During that 90-day extension period, you’re entitled to up to $10,000 in medical benefits, but no lost wages. You may receive an additional 10% for all late payments from a California-based insurer.
Every state’s laws are different regarding workers’ comp benefits and time limits for insurers to review those claims. It is best to contact an experienced workers’ comp attorney in your state for a free case review.
7. Limiting Which Doctors Can Treat You
Some states require you to see a doctor your employer chooses to treat your workplace injury or illness. In such cases, seeking medical care from a provider without prior authorization means you must pay those bills yourself.
In other states, you can see any doctor you choose to treat your workers’ compensation injury or illness. However, one of the least well-known workers’ comp adjuster tricks involves pushing you to see the insurance company’s preferred doctor. It’s important to understand what your rights are when it comes to selecting a workers’ comp doctor in your state. A local workers’ comp attorney can explain what options you have according to your state’s laws.
8. Scheduling an Independent Medical Exam (IME)
Insurance companies may schedule an independent medical exam with a doctor that works for the insurer. These IME physicians are there to examine you and provide a second opinion on your injury or illness. Insurers often choose IME physicians who will side with them — and potentially against you.
Although you can’t refuse an IME, you should be careful what you say during one and stick to your symptoms.
Some advice when meeting an IME physician is:
- Focus on your injuries, how they affect your daily routine and limit your ability to work. Don’t offer up unnecessary information; stay on topic.
- Request a copy of your exam report. You’re entitled to this, so be sure to always ask for it.
- Always follow recommendations from your treating physician.
If your physician and the IME doctor disagree, you can dispute it with medical evidence.
9. Blaming Your Injury on Pre-Existing Conditions
Sometimes, insurance adjusters blame your current injury on pre-existing conditions. Of all workers’ comp adjuster tricks, this is usually the easiest way for insurers to deny you benefits.
Remember that even if you do have a pre-existing condition, it doesn’t automatically make you ineligible for workers’ comp benefits. If a recent job accident aggravates an old injury, then you may still qualify for workers’ compensation. In Missouri, for example, you must show your job is a “prevailing factor” in your work-related injury to secure benefits.
Always consult an attorney if you have a pre-existing injury that could complicate your workers’ comp case. They know how to make sure your case isn’t derailed by this or other, similar workers’ comp adjuster tricks.
10. Giving You Inaccurate or Incomplete Forms to Sign
Some employers provide an awards agreement form that lets them avoid paying any workers’ compensation benefits until you sign it. Other times, they might provide you with a First Report of Injury form to sign without any fields filled in. Never sign any blank forms from your employer or their insurer. Furthermore, you should never sign any legally binding form or contract without reading it first.
An experienced attorney specializing in workers’ comp can review any forms you receive before you sign anything. Some of these forms may have missing information that will limit or possibly deny your workers’ comp benefits. An attorney can ensure the workers’ comp adjuster tricks listed above have zero impact on your case.
How to Fight Against These Workers’ Comp Adjuster Tricks
If you’re hurt at work, use these tips to fight against workers’ comp adjuster tricks once you file your claim:
- Ask for everything in writing. Anything done in writing can be used as evidence for what you’ve communicated with the adjuster.
- Always describe your injury as “work-related.” Workers’ comp benefits only pay for work-related injuries. Don’t get tricked into saying your injury happened outside of your workplace or you’ve had similar injuries before.
- Never say the words “I feel okay.” Insurance adjusters can find sneaky ways to have you say “I’m feeling better” or “I’m okay” without asking you directly. It may make the adjuster believe you don’t need medical care, leading to your claim’s denial. Don’t exaggerate your injury, either, but do let them know you’re still receiving treatment from a doctor.
- Stick to the facts. Don’t speculate, exaggerate, or minimize. If you give slightly different answers every time you speak, the claims adjuster can use that inconsistency against you.
- Don’t ramble. Never give a claims adjuster personal information they could potentially use against you, even if you think it’s not relevant. Focus on giving direct, short answers to questions and limit any discussion to your on-the-job accident.
- Never guess. If you’re unsure of an answer, reply honestly by saying, I don’t know. Inconsistent answers from you can open holes for the workers’ comp claims adjuster to deny or reduce your benefits.
It’s best to seek a local legal expert to review your claim. LegalASAP provides a free consultation to answer any questions or concerns you may have.
The Best Defense Against Workers’ Comp Adjuster Tricks: An Experienced Attorney
Seeking legal guidance is the best option after an injury at work. LegalASAP would like to help you connect with an attorney specialized in your case.
Understanding the law within your state will help you know your rights, and a workers’ comp attorney can explain it all. We are partners with 500+ law firms spread across the United States. You can contact us at 888-927-3080 or fill out this quick evaluation form. Someone will reach out to you by phone to discuss your claim as soon as possible during weekday business hours.
Cassandra Tran Nguy is a legal writer living in Los Angeles, California. She graduated cum laude from California State University, Northridge with a B.A. in English Creative Writing and a minor in Marketing. Visit her online profile at linkedin.com