What Does a Workers’ Comp Claim Adjuster Do?

If you were hurt and are considering seeking Workers’ Compensation benefits for your injury, you are going to spend a lot of time in communication with a claim adjuster.  It is important to understand what they do so that you know what you should feel comfortable disclosing to them and when you should leave discussions to your attorney.

In general, the claim adjuster is going to be the main point of contact you have with the insurance carrier your employer uses to pay your Workers’ Comp benefits.  They will have to coordinate with you to get medical records, doctor’s notes, evidence of your injury, proof of pay, doctor’s appointments for exams, transportation to court-ordered exams, and a million other things.  At the end of the day, Workers’ Comp adjusters work for the opponent and want to close your case cheaply and quickly or deny the entire claim where possible.  All of that cuts directly against your goal and our attorneys’ goals: to get you the benefits you need and deserve.

For help with your case, call the Certified Pennsylvania Workers’ Compensation Lawyers at Cardamone Law at (267) 651-7945.

What is a Workers’ Comp Adjuster’s Role in My Case?

The Workers’ Comp adjuster is the main point of contact you will have with the insurance carrier.  They will be the one to call you and ask for paperwork and records.  They will also be the one making the preliminary decisions about whether to grant your case and how much to award you, though their supervisors may make the final call.

Generally, their job is to protect the insurance carrier’s bottom line and to close cases quickly – which often means denying them at any reasonable chance they get.

Should I Talk to Insurance Adjusters if I Have a Pending Worker’s Comp Case?

Generally, you should avoid talking to insurance and let your lawyers handle it for you.  However, the practical fact of the matter is that you are going to have to interface with an insurance adjuster a lot during the course of your claim.

During your initial claim with your employer and their insurance, the insurance carrier will assign an adjuster to reach out to you for all of the information they need about the claim to decide how much to pay you.  That means they will need your medical records, your evidence of the injury, and anything else they ask you for.  They will also be the one to coordinate care and medical exams – but it might not be clear which of those are for your benefit and which are for the insurance carrier’s investigation of the case.

All in all, you usually cannot avoid talking to Workers’ Comp adjusters, even if it would be better to leave all communications to your attorney.  Even so, there are steps you should take to make sure you are not giving away anything important to the insurance company without your lawyer’s approval.

What Should I Avoid Saying to Workers’ Comp Adjusters in Pennsylvania?

Given that the Workers’ Comp adjuster ultimately works for the opponent in your case, you should avoid giving them any information that could be used against you.  You should also be forthright with any facts you give them and never lie or twist the truth, and review what you should and should not say with a lawyer first.

Insurance companies will use any admissions from you to deny your claim, especially if they can be interpreted as proof that your injury did not actually happen at work.  Make sure that you are very clear about the facts of your case and discuss where and when things happened.

Insurance adjusters will also seek to cut off benefits when they are allowed to, meaning that you should stick to your doctor’s recommendations and avoid doing anything or reporting any improvements in condition to the adjuster without going over them with your attorney first.  For example, you should not tell them that you were out playing tennis if you are under doctor’s orders to avoid physical activity – but then again, you also should not be out playing tennis!

Can I Give a Recorded Statement to a Workers’ Comp Insurance Adjuster?

Giving recorded statements is risky, but it might be required.  Many conversations and phone calls with insurance adjusters are ultimately recorded, and it might be impossible to get your claim heard and do business with the insurance carrier without going on a recorded call.

You should generally treat all discussions with Workers’ Comp insurance adjusters like they are recorded and avoid saying anything false or misleading or anything that can be twisted or misinterpreted to hurt your case.

Can My Lawyer Help Me with Workers’ Comp Insurance Adjusters in Pennsylvania?

If you were hurt in a work injury, your first call should be to our Bensalem, PA Workers’ Compensation lawyers.  We can advise you as to what to do next, what info the Workers’ Comp adjuster will need for your case, and what you should and should not say to them.  But this is just the start of how we can help you with the Workers’ Comp case.

After you begin with a claim to your employer, they will ultimately send the case to their insurance carrier, who will have an adjuster decide whether or not to pay the claim and how much to pay.  From there, if there are any mistakes in what they award you, if they deny your claim, or if they simply ignore your calls and never get back to you, we can take the case before a Workers’ Comp Judge (WCJ) to handle the claim that way.

Once we get the case before a WCJ, the Workers’ Comp carrier’s role gets more complicated, and the insurance carrier may use specialized adjusters or even turn to their legal team instead of leaving the rest of the case to the insurance adjuster.  Workers’ Comp cases are more formal at this stage, and WCJs will handle a lot of the decisions, evidence collection, requests for exams, and interactions between the two parties.

At this stage, you should always work with a lawyer, given the sophistication of the process and the fact that there might be evidence we need to pay to collect – such as opinions from outside doctors.  You should not be left without counsel and left to pay for these things on your own.

Call Our Workers’ Compensation Attorneys in Pennsylvania Today

Contact Cardamone Law’s Philadelphia Workers’ Compensation lawyers today at (267) 651-7945 for a free review of your case before you speak to any Workers’ Comp adjusters.