Common Workers' Comp Adjuster Tactics
When you've been hurt at work, you need to protect your rights
When you suffer an injury on the job, you expect your workers' compensation benefits to cover your medical bills and lost wages. Unfortunately, insurance companies don't always see it that way. Adjusters often use tactics to limit or deny claims.
Understanding these tricks can help you protect yourself and secure the compensation you deserve. The New York workers' comp attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP know the strategies insurance companies use and will fight to protect your rights.
Here are common tactics workers' comp adjusters use and how to protect yourself.
1. Looking for a recorded statement
After you file a workers' comp claim, an adjuster may ask you to provide a recorded statement. This request might seem harmless, but it's often a trap. Adjusters use these statements to gather information they can twist to the insurance company's advantage.
They know how to ask leading questions that might cause you to misspeak or misinterpret something. For example, an adjuster might ask you to describe your injury in detail. You could inadvertently say something that contradicts what you previously told your doctor, or you might unintentionally downplay your pain.
Even small inconsistencies can give the insurer a reason to question your credibility and reduce or deny your claim. Never give a recorded statement without first speaking to an experienced workers' comp attorney. A lawyer can guide you in handling the adjuster's questions and protecting your rights.
2. Convincing you to sign a medical records release form
Insurance companies need access to your medical records to verify your injury and determine whether it's work-related. However, adjusters often push you to sign a broad medical records release form, which gives them access to your entire medical history.
By signing a blanket release, you allow the adjuster to dig into your past health issues, even those unrelated to your work injury. They might find something they can use to argue that your work injury resulted from a pre-existing condition rather than your job.
They could also try to influence your doctor's recommendations by gaining direct access to them, possibly pressuring the doctor to clear you for work before you're ready. To protect yourself, limit the release of your medical records to information directly related to your workplace injury.
3. Convincing you to accept a lowball settlement
When you're injured and unable to work, your financial situation can quickly become disastrous. Medical bills pile up, and you lose wages. Insurance companies know this and may take advantage by offering you a quick, lowball settlement.
This offer might initially seem tempting, especially when you're hurt and struggling to make ends meet. However, the first offer is often far less than you're entitled to recover under New York law. Accepting a low settlement could leave you without enough money to cover your medical expenses and lost wages. Once you accept, it's nearly impossible to get more money later.
It's better to wait and secure a fair deal than to settle for less out of desperation. Instead of accepting the first offer, let a New York workers' compensation attorney fight to ensure you receive the full compensation you deserve.
4. Sending private investigators to gather evidence against you
After you file a workers' comp claim, the insurance company that pays your benefits may hire a private investigator to watch you, which is perfectly legal. Investigators look for any evidence that you might be exaggerating or faking your injury.
For example, if you claim you injured your back at work, but an investigator catches you carrying groceries or mowing your lawn, the insurance company might use this against you. Even if you're genuinely in pain, activities that seem harmless can make it appear otherwise.
Social media can also be a problem. If you post photos or videos that seem to contradict your injury, the insurance company could use them against you. For example, a picture of you doing something active out in public might raise questions about the severity of your injury and your ability to work.
Protect yourself by being consistent in your actions. Avoid doing anything that contradicts your work injury claim, and adhere to all legal and medical advice.
5. Asking trick questions to catch you off guard
Even if you refuse to give a recorded statement, adjusters may still try to catch you off guard in casual conversations. They might ask seemingly innocent questions, hoping you'll speculate or provide opinions that could harm your case. For example, they could suggest your injury happened outside of work or that it's related to an old accident or illness.
When speaking with an adjuster, keep your answers short and to the point. Don't offer more information than necessary, and avoid speculating about the severity of your injury or your prognosis. If you're unsure about something, it's better to say "I don't know" than to guess.
6. Delaying your workers' compensation benefits
Insurance companies sometimes intentionally delay workers' comp claims, hoping you give up or accept a low settlement. In New York, insurance companies are generally required to start paying workers' compensation benefits within 18 days of receiving the claim or notice of injury if the injury results in more than seven days of missed work.
If they dispute the claim, they must notify you within 18 days or within 10 days of receiving your employer's notice, whichever is later. Delays beyond these deadlines can result in penalties, including interest on unpaid benefits and fines against the insurer.
7. Attempting to limit which doctors can treat you
In New York, workers' compensation law generally allows injured workers to choose their own doctor from a list of medical providers authorized by the New York State Workers' Compensation Board. However, insurance companies often don't want you to know this.
However, if the employer participates in a Preferred Provider Organization or Alternate Dispute Resolution program, you may be required to see a doctor within that network for the first 30 days of treatment.
8. Scheduling biased independent medical exams
Insurance companies may schedule an independent medical exam (IME) with a doctor who will favor the insurance company. The purpose of the IME is to get a second opinion on your injury or illness. Unfortunately, insurers often choose IME doctors who are more likely to side with them.
You can't refuse an IME, but you can take steps to protect yourself during the exam. Focus on your symptoms and how they affect your daily routine. Don't offer unnecessary information; stick to the facts. Request a copy of the IME report, as you have the right to review it.
If your treating physician and the IME doctor disagree about your condition, you can dispute the IME findings with additional medical evidence.
9. Claiming your injury is pre-existing
One of the easiest ways for insurance companies to deny workers' comp benefits is by blaming your injury on a pre-existing condition. If you've had health issues in the past, the insurer might argue that your current injury stems from those issues rather than a workplace accident.
However, having a pre-existing condition doesn't automatically disqualify you from receiving workers' comp benefits. If your job aggravated an old injury, you may still be eligible for compensation.
If you have a pre-existing condition that could complicate your claim, a New York workers' comp attorney can gather evidence to show that your workplace accident caused or worsened your injury.
10. Asking you to sign inaccurate or incomplete forms
Insurance companies may provide you with forms that seem straightforward but contain hidden traps. For example, your employer might ask you to sign an awards agreement form, which could delay or deny your workers' comp benefits until you sign it.
Alternatively, they might give you a First Report of Work-Related Injury/Illness form with blank fields, asking you to sign it without reviewing the information.
Never sign any form without reading it thoroughly. Incomplete or inaccurate forms can jeopardize your claim and limit your benefits. If you're unsure about any form, have a workers' comp attorney review it before you sign. A lawyer can ensure that the insurance company isn't using deceptive tactics to deny your claim.
How else can I protect myself from workers' comp adjustment tactics?
If you've been injured at work in New York, you can protect your rights by staying vigilant and using these best practices:
- Get everything in writing: Written communication provides a record of your interactions with the adjuster and can serve as evidence if disputes arise.
- Always refer to your injury as work-related: Workers' comp benefits only cover work-related injuries. Avoid any statements that could suggest your injury occurred outside of work or was influenced by other factors.
- Keep copies of everything: Save all documents related to your injury and claim, including medical records, bills, and correspondence with the insurance company.
Our New York workers' comp attorneys can fight back against adjuster tactics
Facing insurance company delays after a workplace injury can be incredibly frustrating, especially when you're already dealing with pain and financial stress. When the insurance companies try to use their tactics to reduce or deny your claim, the attorneys at Pasternack Tilker Ziegler Walsh Stanton & Romano LLP stand ready to counter them.
We've spent decades taking on insurance companies that try to avoid their responsibilities. We fight to ensure our clients receive the compensation they deserve. Our New York workers' compensation law firm prepares every case as if it's going to trial, which often compels insurance companies to settle favorably before court.
We understand the system and know how to push back against delays and lowball offers. Don't let the insurance company dictate your future. Let us help you secure the benefits and compensation you're entitled to under New York law. Contact us today for a free consultation or call one of our law offices in NYC or New York State.
Click here to download a printable PDF of this article, "Common Workers' Comp Adjuster Tactics."