Disclaimer: Please note nothing in this article is to be considered legal advice. You should always consult with an attorney about the specific facts of your situation before making any legal decisions. No attorney/client relationship or representation relationship is created by the dissemination of this content or your consumption thereof.
If you have been injured on the job, your first step is to notify your employer. It will be your employer’s insurance that will be on the hook to pay for your injuries. This process means an insurance adjuster will be assigned to your case, and their main goal is the opposite of yours. You want benefits. They do not desire to give them to you. With the assistance of a Virginia workers’ compensation attorney who understands the process and tactics of insurance adjusters, you are more likely to receive a higher compensation amount or the benefits you need.
Settlements are voluntary agreements between the claimant and the insurance company. Nobody can force anyone to take a settlement or to pay a settlement in Virginia. When both parties agree, however, that settlement can arrive in various ways, from a lump sum to installments. Settlements may pay out the whole workers’ comp claim or just parts of it, such as with an indemnity-only or medical-only settlement.
Both pros and cons exist for each type. For example, receiving a lump sum for the full amount of the settlement to close out your case entirely may seem satisfactory, but what if you are due additional compensation for your injuries at a later date? The closing of the injury claim coincides with the payout, and now you have no more opportunities to gain additional benefits. Working with an experienced workers’ compensation benefits attorney may be beneficial to your case and help you find the best option.
Another reason to stay alert during this claims process is that insurance companies may make voluntary payments following an employer’s reporting of the injury to the Virginia Workers’ Compensation Commission. By making these payments, they hope that the statute of limitations on your injury will expire before you file your own claim with the Commission. In Virginia, injured workers only have two years from the date of the work-related accident to file that claim with the Commission. You must make this filing deadline to protect your rights under workers’ compensation law and to receive an award order. This order shows that the employer’s insurance company has a legal obligation to your claim.
Every workers’ compensation case is different, so there is no defined answer to how long a workers’ comp settlement will take. It is not uncommon for a Virginia workers’ comp case to take over a year to wind through the litigation process, but this varies widely depending on a whole host of factors. The good news here is you may be able to speed up the process with the help of a workers’ compensation lawyer.
Workers’ compensation insurance adjusters do not want what is best for you as an injured employee. Rather, they want to keep their money and pay out as little as possible. This motive is why they sometimes come to you in a friendly and polite manner at first. They want you to accept whatever low offer they initially make.
Their job is not to inform you about the available workers’ compensation benefits and how to receive them but to simultaneously protect your employer and the insurance carrier. So, remain cautious when dealing with the insurance adjuster, no matter how friendly they may appear.
Workers’ comp insurance adjusters will often use common tactics and tricks to throw you off guard and help them reach their goals only. You will benefit from knowing what these are and how best to combat them so they cannot take advantage of you.
In some cases, an adjuster may have a workers’ comp investigator follow you. The goal of such private investigators will be to capture video footage or photos, hopefully showing you doing something that conflicts with your work restrictions. The adjuster will then use these to show you are being dishonest about your disability to the Workers’ Compensation Commission or your doctor. They might even threaten to report you for fraud, and this can be a scare tactic to encourage you to accept a lower settlement offer than you deserve.
If this happens to you, try to stay calm. Your workers’ compensation attorney may be able to use legal procedures to determine the accuracy of the evidence. For example, a video may show that you perform certain physical activities yet not show that you only did so for a short period of time and then had to rest for the next two days. A workers’ compensation judge will most likely understand that short-term activity does not constitute fraud and that it does not prove you can return to work in a full capacity.
Any benefits you receive will come from the insurance agency of your employer, not from the Virginia Workers’ Compensation Commission. Being unable to work, you depend on these payments to arrive on time. When they do not, you may become stressed, and this is exactly what the adjuster wants. Delaying benefit checks and causing desperation is a way to force you into accepting a lower settlement. For help with these types of workers comp adjuster tricks, contact an attorney to speak on your behalf.
The adjuster may offer you an insufficient settlement quickly, so you have less time to consider your rights and options. Many offers involve scare tactics, such as telling you how long the process takes and how benefits can be delayed. They may tell you that the volume of information needed to review a worker’s compensation claim is massive, and you can alleviate yourself of this burden by accepting the generous settlement they are now offering now.
In addition, the adjuster may send you an agreement form that leaves out important information. For instance, the form may calculate the amount using a lower average weekly wage or fail to provide enough wage loss benefits for the time you, the injured employee, are already out of work. In other instances, the adjuster purposely fails to list all injured body parts from the work-related accident, potentially eliminating coverage for many medical bills.
The adjuster may ask you to sign a statement or give a recorded statement over the phone immediately following your work-related injury. They may even present this as a normal step in the process and necessary to move forward.
The reason behind this tactic may be that they are attempting to get you to admit to certain facts that show the injury is not work-related or that the accident itself is not covered under workers’ comp benefits law. The adjuster will ask the questions in a way that elicits the type of responses they can use against your claim.
In other words, signing a statement immediately or giving a recorded statement on the phone can come back to haunt you and your claim, potentially leading to a denial of coverage, medical treatment, or wage loss benefits.
So, what should you do if asked to sign or provide a recorded statement? Contact a lawyer. If the adjuster says you must give a statement to receive benefits, reach out to a worker’s comp attorney for legal advice and guidance.
The claims adjuster may ask you to sign a consent for your medical history records so they can better assess your claim more quickly. It is easy to fall for this tactic, wanting to believe the best of people in these circumstances.
Such a consent, or medical authorization form, is usually vague and directs your medical care providers to release health records to the workers’ comp adjuster. Once there is receipt of records, the adjuster knows what to look for to deny you benefits, such as prior accidents and injuries, pre-existing conditions, or separate medical issues unrelated to your workers’ comp claim.
Avoid signing a consent for records until you consult with your attorney. A claimant is not legally obligated to give consent in exchange for benefits available under workers’ compensation.
You are most likely anxious to know where your claim is in the process and will make several calls or send emails to the adjuster for updates. Unfortunately, the adjuster may miss your calls on purpose and fail to respond to those emails. After leaving several messages, you can quickly become frustrated. They may be trying to push you into a mental place where you will give up on the claim and be more ready to accept a lowball settlement offer.
Knowing this is a deliberate tactic can help you avoid falling prey to it. To push for answers and updates, seek legal advice, and leave that frustration behind. Learn ways to get the most from your claim without caving to the tactics of the insurance company adjusters.
When you do talk with an insurance adjuster, there are a few things you need to avoid. You should avoid agreeing to anything, verbally or in writing, until you completely understand what is being offered or asked of you.
Also, unless you are highly knowledgeable in common workers’ compensation rights and benefits, resist negotiating a settlement. If you do, you increase the risk of accepting an offer that does not include all the benefits you may be entitled to now or in the future. A better option is to consult with a lawyer before talking to the insurance company. A lawyer may be able to give you guidance on what to do and what to avoid to obtain your benefits.
It is important to remember that no matter how friendly the adjuster is, they are not your friend. While you do not have to be rude, you do need to remain confident if you decide to deal with the insurance claims adjuster yourself. Here are some tips to help.
Remain polite and treat the adjuster with respect even when you disagree or become frustrated at the process. Return phone calls, letters, or emails and, if you do hire an attorney at some point, let them know and provide the contact information for the law firm.
If the adjuster requests you sign a statement, a consent for medical records, or any other document, especially one you do not understand, you can refuse. You do not need to sign anything, especially early on in the process.
Keep the exchange of information strictly professional and associated with the work-related injury and accident. Do not offer personal information, such as your current financial situation, your family life, or details of any past personal injury, illness, or pre-existing medical conditions. Also, avoid sharing any contradictory posts on social media as adjusters can find these and use them against you.
Your claim is not the only one an adjuster will be handling at any given time. Their caseloads for insurance claims can be quite large, which means you will need to stay persistent to get their attention focused on yours. Set a schedule for contacting the adjuster, such as every 30 days or so, to check on the status of your case and such things as approval of medical treatments.
Ask the adjuster questions. Just be sure those questions are well-researched and not the result of frustration or fear. Try asking them what they need to move forward with your claim. By doing so, you gain a better picture of where they are in the process and what is most important to them in making an assessment.
If the adjuster says you do not qualify for wage loss benefits, ask why specifically. You may need to return to your treating physician for defined work restrictions. Also, ask how long it should take for the adjuster to make a decision.
Following an injury at work, you will have a lot on your mind as you continue medical treatments and possibly even rehabilitation. It is at this point you may be considering whether to hire an experienced workers’ compensation attorney and if, by doing so, you can get more money.
An attorney may be able to help you through the workers’ compensation process by talking to the insurance company and the Virginia Workers’ Compensation Commission on your behalf. With experience in workers’ compensation law, your attorney already understands the benefits you are eligible for and will work to obtain the compensation payout for those benefits.
Studies show that having an attorney is usually advantageous for getting more money from your claim. According to one survey, claimants working with legal representation typically received approximately three times the amount of unrepresented claimants.
Suffering a work-related injury and enduring the complicated workers’ compensation process that follows can be overwhelming. Your employer’s insurance carrier will assign an adjuster to evaluate your claim and make a determination of benefits. Yet, the adjuster’s goal is to settle your claim for much less than it is worth. Do not let this happen to you!
Avoid falling for the insurance adjuster’s tricks and tactics by consulting with a Virginia workers’ comp lawyer here at the law office of Pathfinder Injury Law. Give us a call today at phone number 804-505-0633 or submit our online contact form to get started with a free consultation.