Watch out for these workers’ comp adjuster tricks intended to reduce your payout. Get every dollar of compensation you deserve for a work injury.
Let’s assume you suffer a workplace injury and file a workers’ compensation claim. The insurance carrier accepts your claim and assigns an adjuster to oversee your benefits.
The adjuster tells you the insurance company will fully cover the cost of your medical treatment and pay wage benefits while you’re unable to work.
The above scenario sounds like how a workers’ compensation case should work. Unfortunately, it’s often not this easy.
Insurance adjusters have a bag of tricks commonly used to reduce the amount of benefits they have to pay out. Common tactics include incorrectly calculating wage benefits, trying to get you to make statements that harm your claim, hiring investigators to spy on you, and more.
Here we unpack the most common adjuster tactics and give you ways to handle tricky adjusters.
Watch Out for These 6 Adjuster Tricks
Just as with any other type of claims adjuster, the worker’s comp adjuster is not your friend. Be especially careful with one who acts friendly and sympathetic. Don’t be lulled into making mistakes that can reduce or terminate your benefits.
1. Pushing Claimants to Give a Recorded Statement
Be wary if the adjuster wants you to make a recorded statement. This is where the adjuster records you, on the phone or sometimes video, while you discuss your work-related injury. Adjusters are trained to ask leading questions, or make comments and get you to agree.
During the recording, the adjuster will try to get you to say things they can use to deny your claim or reduce your benefits. For example, they might try to have you minimize your pain or suggest that you were injured outside of work.
The adjuster might lead you to believe you have to give a recorded statement or lose your benefits. You are not legally obligated to provide a recorded statement to get workers’ comp benefits. The workers’ comp claim form you submitted will have a description of when and how you were injured on the job.
Never agree to a recorded statement when you’re confused, upset, or while taking pain medications. Better still, don’t agree to a recorded statement before consulting an experienced workers’ compensation lawyer.
2. Asking for a Comprehensive Medical Release Form
The insurance adjuster is only entitled to copies of the medical records pertaining to your workplace injury. Never sign a “blanket” form that doesn’t specify the dates and medical providers for the records you’re willing to release to the workers’ comp insurance company.
The adjuster is not entitled to your medical history prior to the work injury, mental health records, or unrelated medical care and treatment you may receive while recovering from your work injury.
3. Hiring Investigators to Watch Injured Workers
It’s perfectly legal for workers’ comp insurers to hire private investigators to watch you outside your home and on social media. The investigator’s job is to capture you doing something inconsistent with your claim. The adjuster does not have to inform you of the investigation.
Just like in the movies, a “private eye” can sit in a car outside your home, or follow you around when you go out. They can’t peek through your home’s windows, but anything they can see from the street is fair game. Investigators may also interview a vindictive family member or neighbor who is willing to say you’re faking or exaggerating an injury.
A similar tactic is for investigators to watch social media accounts for anything you post, or posts by others where you are tagged. Adjusters are after pictures or videos of an injured worker that are at odds with the facts of their claim.
For example, the insurance company can reduce your benefits or deny them altogether if you file a workers’ comp claim for a shoulder injury, and an investigation turns up video of you painting your house or rock climbing with friends.
Sometimes an insurance company may use the results of an investigation to allege you filed a fraudulent claim.
4. Offering Incomplete or Inaccurate Forms for Signature
Sometimes claims adjusters will prepare forms for you to sign that are missing pertinent information. The error may be an unintended oversite, but rarely will incorrect paperwork be in your favor.
Incorrect wage benefit calculations are the most common worker’s comp paperwork error. Make sure you understand how your wage benefits are calculated, then double-check the calculations for yourself.
For example, if your regular paycheck includes a gas allowance, food allowance, or other perks, most state workers’ compensation laws allow your wage reimbursement to include those perks, not just your base hourly wages.
If you sign off on an incorrect wage calculation, it’s difficult (if not impossible) to get it corrected.
Or, the adjuster may draft a form that doesn’t include all of the pain, symptoms, and difficulties related to your injury. If you sign the form, the adjuster can later reduce your benefits because your injury is less severe than you originally claimed it was.
Make sure you carefully review any document that an adjuster wants you to sign. Pay attention to details and have an adjuster change any inaccurate or missing information.
5. Making a Quick Lowball Settlement Offer
Workers are sometimes eager to collect their workers’ comp benefits. Adjusters know this and will sometimes try to offer injured workers a quick lowball settlement for their claim.
If a worker accepts the offer, the adjuster saves their insurer money and can close out the claim.
Be wary of any quick attempt to resolve your claim. If you receive a settlement offer, ensure that it’s for a fair value consistent with your medical bills and lost wages.
6. Scheduling an Independent Medical Exam
Sometimes an insurer will send an injured worker to an Independent Medical Exam (IME) to get a second opinion. IME doctors work for the insurance company and not you.
The adjuster might ask for an IME if your treating physician thinks you are disabled, or wants to refer you to a specialist for further treatment or consultation.
The sole purpose of the IME is to give the insurance company an “expert” opinion on your ability to get back to work and stop collecting benefits. The examination is not given to provide medical treatment or care.
While you can’t refuse an IME, workers should disclose only essential information during the examination. It’s okay to discuss the details concerning your pain and physical limitations. However, try not to go beyond these areas.
Handling Communications with the Adjuster
Claims adjusters might try to find an excuse to reduce your workers’ compensation benefits by twisting your words around, using your comments out of context, or getting you to agree to statements that aren’t necessarily true.
If you choose to speak with an adjuster, use caution, be polite, and think before you speak. Also, keep in mind that some things are best left unsaid.
Ways to protect yourself from workers’ comp adjuster tricks:
- Ask for Written Communications: It’s okay to ask for all communications with the adjuster to be in writing. In some cases, injured employees may only want to provide an adjuster with their name, address, phone number, and personal email.
- Insist Your Injury was Work-Related: Workers’ compensation only pays benefits to employees who suffer a work-related accident. Don’t fall into any traps that lead you to say or even hint that your injury occurred outside the workplace.
- Say You’re Not Feeling Okay: In an attempt to deny payment for medical expenses, an adjuster may try to get you to say that you’re “feeling okay” by asking, “How are you feeling today?” If you’re truly feeling fine, then there’s no reason for medical care, and no reason for an insurer to pay for treatment. Don’t exaggerate your injury, but make sure you tell the adjuster you’re still under a doctor’s care.
- Don’t Guess or Offer Opinions: If you give an adjuster inconsistent facts about your case, they’ll use them to reduce your payout or terminate your claim. If you’re unfamiliar with any specifics of your claim, say “I don’t know.” Be careful if an adjuster asks questions regarding your medical care. They can always look at your medical records if they have questions about your treatment.
- Address Pre-Existing Injuries: A pre-existing injury will not disqualify an injured worker from receiving workers’ comp benefits. You can still receive benefits if a current work injury made a prior injury worse. Be clear that you are suffering new pain and symptoms that are distinct from the prior injury or condition.
- Stay On Topic: Don’t provide an adjuster with details about your family, your medical history, or your finances. Your personal life is not relevant to your work injury and is none of the adjuster’s business.
Maximizing Your Workers’ Compensation Payout
The best way to maximize your workers’ comp payout is to be honest, consistent, and watch what you say and do.
Employees who suffer mild injuries can submit a workers’ compensation claim and communicate with the adjuster independently. If you fully recovered and returned to work in a few days or weeks, you can receive fair benefits without the help of a law firm.
Workers’ comp insurance adjusters tend to save their bag of tricks for high-dollar injury claims. Severe or complicated injury claims are best handled by an experienced workers’ compensation attorney.
Consider seeking legal advice when the adjuster:
- Asks for a recorded statement
- Won’t correct your wage benefit calculations
- Wants to schedule an IME
- Interferes in your medical care
You have the right to consult with a personal injury lawyer at any time during your workers’ comp claim before accepting a settlement offer.
Don’t let the adjuster tell you that you don’t need or can’t afford an attorney. Workers’ comp lawyers generally offer a free consultation. Most states also limit the legal fees for workers’ comp cases.
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