Dealing With Adjusters in Texas Workers’ Compensation Cases

August 3, 2016 12:50 pm Published by Leave your thoughts

You have been injured on the job and have been to the doctor, received some initial medical treatment and have started receiving paperwork from the insurance company about your injuries. In this mountain of paperwork that will be mailed to you, the insurance company is going to inform you that an adjuster has been assigned to handle your claim. Many injured workers’ will read the paperwork and believe the information provided to them by the insurance carrier, that the adjuster is assigned to handle your claim and assist you in your claim, and that they are provided to you by the insurance company to help you navigate the workers’ compensation system. For many people this on the job injury is the only one that they have ever had and this will be their only experience dealing with an insurance company for a work-related claim. However, many times injured workers quickly find out that what they initially believed are wrong and the exact opposite is true.

All too often injured workers contact our office with the complaint that the adjuster that has been assigned to their claim has become, or has always been non-responsive, they do not return calls, either from the injured worker themselves or from the doctors that are treating him or her, if they have provided their e-mail addresses they do not respond to emails. The amount of contact information initially provided by the adjuster varies; sometimes they provide their direct line and/or extension, fax number, and sometimes even an e-mail address. Other times it is just the toll-free number to the insurance carrier, leaving the injured worker to navigate a sometimes hopeless and always frustrating series of call-centers “press 1 for claims, press 2 for our fax information” call center automated responses.

One case stands out in particular, an injured employee contacted our office because they had been injured about six months prior, and had been released to return to work in a modified light duty capacity for about four months of that time. Doing their own research the injured employee had discovered that because he was released to work light duty, if he was working fewer hours and earning less wages on a weekly basis than prior to his injury, he should have been entitled to partial benefits from the insurance company for lost wages. Of course neither the employer, nor the insurance adjuster had informed the worker of that bit of information regarding lost time. Knowing that he worked fewer hours every week because of his restrictions from his injury he attempted to contact the adjuster almost every day for almost a month to discuss this and attempt to find out what documentation he needed and to get the benefits that he deserved to help get him and his family through this time. Out of frustration he contacted our office, once our office got involved we obtained the information regarding lost wages, forced the issue with the adjuster and the insurance company, and within a month had the injured employee the back pay that he was entitled too as well as weekly benefits going forward in order to make up for the lost wages and time he was missing from work because of his injury.

Make no mistake. The insurance adjuster at the end of the day is not there to assist you as the injured employee. The adjuster is assigned to the claim to monitor the claim, and manage the claim on the Insurance Carrier’s behalf. Yes, the adjuster is on the claim to see that the insurance company’s interests are served on the claim. What is the insurance company’s interest? To ensure that the injured workers’ claim for medical and disability benefits pays out at the lowest amount possible. Like all companies the insurance company is there to make a profit, and they do this by limiting the financial and medical liability that they are open to through the claims that they are liable on.

What is one of the fastest ways to ensure that nothing is getting done, and thus, making sure that nothing is getting paid for on a claim? Not responding to requests for information, not providing the doctors with the relevant information they may need, and generally ignoring the injured workers’ claim in the assumption that maybe the injured worker would give up and quit trying to contact them perhaps? Sadly, this is an almost every day fact of some workers’ compensation claims. Many times adjusters have to give out certain information when requested, and the easiest way to make sure that that information doesn’t get out is to make sure that they are hard to get into contact with.

You, as an injured employee are not alone, and you should not have to face this frustrating, and unfair practice alone. At Abbot, Clay & Reed we know how insurance companies function and how their adjusters work. With the combined years of experience in Texas Workers’ Compensation our attorney’s know how to “climb the ladder” at the insurance companies, how to get management on the phone, the proper paperwork to file, and, if needed the proper grievances to file in order to force the insurance company and their adjuster to respond to us, or the doctors that are seeking information.

You are not alone, if you have been having trouble with the insurance company, or perhaps not getting any information from the insurance adjuster assigned to your claim. Call us today or contact us online and ask how our Attorneys and staff can get you the medical and disability benefits that you deserve.

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