Games Workers’ Comp Adjusters Play & How to Beat Them

Games Workers’ Comp Adjusters Play & How to Beat Them

When you’re injured on the job, you expect your workers’ compensation claim to be handled fairly and efficiently. However, the reality is that many workers’ compensation adjusters engage in tactics designed to minimize the amount of benefits you receive. These “games” can be frustrating and overwhelming, but understanding them can help you navigate the system and get the compensation you deserve.

Understanding the Workers’ Compensation System

The workers’ compensation system is designed to provide benefits to employees who are injured or become ill as a result of their job. These benefits can include medical expenses, lost wages, and disability payments. However, the system is often heavily weighted in favor of employers and their insurance companies, who have a vested interest in keeping costs down.Workers’ compensation adjusters are the individuals responsible for reviewing and processing claims. They are often under pressure to minimize the amount of benefits paid out, which can lead to a variety of tactics designed to deny or reduce claims.

Common Tactics Used by Workers’ Comp Adjusters

1. Delaying the Claim Process

One of the most common tactics used by workers’ comp adjusters is to delay the claims process. This can involve requesting additional information or documentation, or simply taking a long time to make a decision on a claim. The goal is to frustrate the claimant and make them give up on the process.

2. Disputing the Severity of the Injury

Workers’ comp adjusters may also try to dispute the severity of the injury, claiming that it is not as serious as the claimant has reported. This can involve sending the claimant to a company-approved doctor for an independent medical evaluation, or simply arguing that the injury is not severe enough to warrant the requested benefits.

3. Questioning the Cause of the Injury

Another tactic used by workers’ comp adjusters is to question the cause of the injury. They may argue that the injury was not actually work-related, or that the claimant was engaged in some kind of misconduct that contributed to the injury.

4. Surveillance and Investigations

Workers’ comp adjusters may also use surveillance and investigations to try to catch claimants engaging in activities that contradict their claimed level of disability. This can involve hiring private investigators to follow the claimant and take video or photographic evidence of their activities.

5. Offering Low-Ball Settlements

Finally, workers’ comp adjusters may try to offer low-ball settlements to claimants, hoping that they will accept a smaller amount of benefits than they are entitled to.

How to Beat the Games

Fortunately, there are steps you can take to beat the games played by workers’ comp adjusters and get the benefits you deserve.

1. Understand Your Rights

The first step is to understand your rights under the workers’ compensation system. This includes knowing what benefits you are entitled to, what the claims process entails, and what your responsibilities are as a claimant.

2. Document Everything

It’s important to document everything related to your injury and the claims process. This includes keeping detailed records of your medical treatment, any communication with the insurance company or adjuster, and any expenses you incur as a result of your injury.

3. Seek Legal Representation

If you are having trouble navigating the workers’ compensation system or are facing pushback from the insurance company, it may be worth considering hiring a workers’ compensation attorney. An attorney can help you understand your rights, negotiate with the insurance company, and represent you in any disputes or appeals.

4. Be Persistent and Assertive

Finally, it’s important to be persistent and assertive in your dealings with the workers’ compensation system. Don’t be afraid to ask questions, request information, and push back against any tactics used by the adjuster to deny or minimize your claim.

Conclusion

The workers’ compensation system can be a minefield of tactics and games designed to minimize the benefits paid out to injured workers. By understanding these tactics and taking steps to protect your rights, you can increase your chances of getting the compensation you deserve.

FAQ

1. What is workers’ compensation?
   Workers’ compensation is a system of insurance that provides benefits to employees who are injured or become ill as a result of their job. The benefits can include medical expenses, lost wages, and disability payments.
2. What are the most common tactics used by workers’ comp adjusters?
   The most common tactics used by workers’ comp adjusters include delaying the claims process, disputing the severity of the injury, questioning the cause of the injury, using surveillance and investigations, and offering low-ball settlements.
3. How can I beat the games played by workers’ comp adjusters?
   To beat the games played by workers’ comp adjusters, you should:
   • Understand your rights under the workers’ compensation system
   • Document everything related to your injury and the claims process
   • Seek legal representation from a workers’ compensation attorney
   • Be persistent and assertive in your dealings with the insurance company
4. What should I do if my claim is denied?
   If your workers’ compensation claim is denied, you have the right to appeal the decision. This may involve requesting a hearing with an administrative law judge or filing a lawsuit against the insurance company. It’s important to act quickly, as there are strict deadlines for filing appeals.
5. Can I be fired for filing a workers’ compensation claim?
   No, it is illegal for an employer to fire or retaliate against an employee for filing a workers’ compensation claim. If you believe you have been fired or retaliated against, you should consult with a workers’ compensation attorney.

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For more information on workers’ compensation, you can visit the U.S. Department of Labor’s website.