Workers’ compensation insurance provides benefits to injured workers, such as reimbursement for medical expenses and a portion of their lost wages while they recover from a work-related injury or illness. With very few exceptions, any Alabama employers who employ 5 or more full- or part-time employees are required to purchase workers’ compensation insurance for their employees.
In Alabama, workers’ compensation is a no-fault insurance system. This means that a worker doesn’t need to prove that their employer was responsible for their injury to receive compensation. Generally speaking, an employee only needs to prove that their injury or illness occurred at their job or resulted from their work duties to be eligible for workers’ comp benefits.
Unfortunately, Alabama’s workers’ compensation system is complicated, and without legal representation, employers and insurance companies often try to take advantage of injured workers to reduce their benefits or deny their claims altogether.
What is an insurance adjuster?
An insurance adjuster is someone who is employed by an insurance company to review claims and determine if someone is eligible for compensation. Some of their duties include:
- Interviewing claimants
- Reviewing and analyzing any documentation related to an accident
- Talking to witnesses
- Approving or denying payments
Ultimately, the primary role of any insurance adjuster is to save the insurance company as much money as possible by finding ways to decrease or avoid payments to injured parties.
What tactics do workers’ comp insurance adjusters use to reduce or deny claims?
Insurance adjusters employ a number of tactics in an effort to reduce the amount of money their company will be required to pay the injured party.
In order to protect your legal rights after a work injury, it’s essential that you be aware of these commonly used workers’ comp insurance adjuster tricks to ensure you don’t make any mistakes that could hurt your chance at compensation.
Delaying payment of your claim
One of the most common insurance adjuster tricks is to put off paying out your claim. The strategy behind this trick is to try to force you to return to work by delaying payment of the money you’re rightfully owed from your claim—money that is needed to pay your bills and provide for yourself and your family.
When faced with the choice to stay home and recover without money or work while injured so they can pay their rent, many workers will return to work. Unfortunately, this often results in additional injuries.
Rather than make a hasty decision to return to work and risk further injury, consult a workers’ comp attorney who can advocate on your behalf and ensure payments are processed in a timely manner.
Offering a quick settlement
The opposite tactic of delaying payment is for the insurance adjuster to make you a quick, low-ball settlement to get you to accept far less than you deserve.
When workers first develop an injury or illness, they often don’t realize how much it could impact their life and health in the future. If your injury later requires extensive rehabilitation or surgeries that you didn’t anticipate, you won’t be able to go back after you accept a settlement offer and ask for more money to cover these expenses down the road.
An experienced worker’s comp attorney can help estimate the value of your case so an insurance adjuster doesn’t take advantage of you.
Denying your physician’s referral
In some instances, your authorized treating physician may refer you to a specialist for consultation following your injury. The insurance adjuster may refuse to give approval for this referral. This is done as a stall tactic to reduce the money the insurance company has to pay out, and it can have serious consequences on your health and recovery.
If you believe an insurance adjuster is trying to prevent you from receiving the doctor-ordered medical treatment you need, you should discuss this with a workers’ comp attorney as soon as possible to prevent further delay.
Tricking you into signing a medical release
One tactic insurance adjusters use to deny your claim is to use your medical records to show that your injury or illness was pre-existing and didn’t result from your job. To accomplish this, they may ask you to sign a medical release giving them complete access to your medical history.
Never sign any release allowing an insurance adjuster to view your medical records without first speaking to a workers’ comp attorney to ensure the release is necessary and appropriate for your claim.
Attempting to get a recorded statement from you
Early on in a claim investigation, an insurance adjuster may try to get you to provide them with a recorded statement, saying that it’s needed to settle your claim.
Following a work accident or injury, a person often experiences emotional distress and pain that can affect their ability to remember details clearly. If you give a statement during this time and later recall something different, the insurance adjuster may use this inconsistency against you, claiming that you’re being dishonest.
Never agree to give a recorded statement without an attorney present to guide you and protect your best interests.
Having you followed by a private investigator
An insurance adjuster may employ the services of a private investigator to follow you around and take photos or videos of you without your knowledge. This is an attempt to prove that your injuries aren’t as serious or debilitating as your claim states. If they’re able to gather photos or other evidence of you doing activities that make it look like your injuries aren’t affecting you, they may use this to deny your claim.
When to contact an Alabama workers’ compensation attorney
Regardless of any tricks used by insurance adjusters, you’re entitled by Alabama law to fair compensation after a work injury or illness. A reputable worker’s comp attorney can inform you of your rights and ensure they’re protected. They can also handle all negotiations with the insurance adjuster so you don’t inadvertently make a mistake that could hurt your claim.
Workers’ compensation claims can be complicated, and it’s essential that you follow all the necessary procedures to ensure you remain eligible for benefits and receive maximum compensation. If you live or work in Birmingham and have been injured on the job, contact the experienced workers’ compensation attorneys at Nomberg Law Firm.
Our attorneys have extensive experience dealing with employers and insurance companies, and we’ll fight to get you the money you deserve. Contact us for a free, no-obligation consultation of your case.
About Nomberg Law Firm
Nomberg Law Firm has been helping people in Alabama recover fair compensation for their injuries since 1967. We know our clients are hard-working men and women who deserve the best representation possible. That’s why we’ve dedicated our entire practice to fighting for your rights after an injury.
The small size of our family-owned firm allows us to focus on our client’s needs and enables us to provide individualized assistance and personal attention that larger firms simply can’t match.