How to Deal with a Workers' Compensation Adjuster
Workers’ compensation provides many useful benefits to employees when injured on the job. However, before you can secure these benefits, your claim must be processed by an adjuster. Claims adjusters are paid to save insurance companies money by denying claims where possible. Therefore, their assessment of your workplace injury or illness can present many obstacles on your route to compensation.
Fortunately, you do not need to face these obstacles alone. Attorney R. Alan Cleveland has dedicated his legal career to advocating on behalf of injury victims throughout Georgia. If you were injured in a workplace accident, he is ready to help you too. Let him put his decades of experience to work for you. Call today a Workers’ Compensation lawyer for a free consultation.
What Is Workers’ Compensation?
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Workers’ compensation is insurance that covers employees when they are injured or become ill at work. It is a no-fault system, meaning that injured workers qualify for benefits regardless of whether they or their employer were responsible for the accident. However, as a tradeoff for these no-fault benefits, employees cannot sue their employer for work-related injuries to recover compensation.
Georgia law requires that most businesses with three or more employees carry workers’ compensation insurance. The requirement applies regardless of whether the employees work full-time or part-time. Eligible employees are covered from their first day on the job and cannot opt-out. However, employers are exempt from providing workers’ compensation to certain kinds of workers, including:
- Railroad workers
- Farmworkers
- Domestic servants
- Certain corporate executives
- Government employees
- Independent contractors
What Can I Recover Through Workers’ Compensation?
Workers’ compensation provides employees with many useful benefits when injured on the job. However, these benefits are governed by strict time limits and dollar caps. Therefore, it is best to have an experienced workers’ compensation attorney review your case to make sure you get everything you are entitled to. The remainder of this section will give a brief summary of the benefits available to injured workers.
First and foremost, workers’ compensation should pay for all reasonable and necessary medical expenses you incur when seeking treatment for your work-related injuries. Medical benefits can last up to 400 weeks. If your injuries are deemed catastrophic, it can even last for life.
Second, injured employees are entitled to disability benefits meant to offset lost wages if their injuries leave them unable to work for more than seven days. These benefits are paid on a weekly basis. They should be equal to two-thirds of your average weekly salary in the thirteen weeks immediately preceding your workplace injury. However, weekly benefits can never exceed $725.
Finally, you may also be able to receive additional disability benefits if you are permanently disabled or lost a body part due to your injuries. The amount of these benefits varies based on the severity of your injuries as determined by an independent medical evaluation.
How Should I Deal with a Workers’ Compensation Claims Adjuster?
You should deal with a workers’ compensation claim adjuster just as you would any other insurance adjuster. As a rule of thumb, remember that a claims adjuster is never your friend.
Insurance companies are for-profit businesses primarily concerned with their bottom line. Therefore, adjusters will look for as many reasons as they can possibly find to reduce your benefits or deny your claim altogether. Do not give them this ammunition. When dealing with an insurance adjuster, these tips should help:
- Remember that you are not having a friendly conversation. Your benefits are on the line, and anything you say can be used against you.
- Promptly report your injury to your employer in writing within the first 30 days after the accident. However, do not provide a recorded statement, sign a medical release form, admit fault for the accident, or accept a settlement offer before hiring legal representation.
- Be forthright. On the one hand, you should not exaggerate or provide misleading information about your injuries. On the other, you do not need to go into great detail before seeking legal representation. Simply inform the adjuster that your attorney will provide the necessary information to process the claim when the time is right.
Common Reasons Workers’ Compensation Claims are Denied
Workers’ compensation claims are governed by lots of bureaucratic fine print. Understandably, injured workers are often left frustrated when their claim is denied because they did not comply with the overwhelming red tape. Among other reasons, adjusters commonly deny workers’ compensation claims because:
- The claimant’s injuries are not related to their job – You can only receive workers’ compensation benefits if your injuries occurred at work or while performing a work-related activity. For example, if you are involved in a car accident while on a sales call, chances are your injuries would be considered related to your job. By contrast, you likely cannot receive workers’ compensation benefits if you are injured while traveling to or from your job as part of your daily commute.
- The claimant waited too long to report their injury – Georgia law requires you to report your injury to your employer within 30 days after the accident. If you do not, you may forfeit your benefits. Therefore, though it is not legally required, you should report your injury in writing to your supervisor as soon as possible. The written notice will serve as evidence in the event of a dispute.
- There is no evidence of injury – Insurers will insist on proof of your medical condition before they pay benefits. If you have not yet seen a doctor for your condition, it will be your word against the adjuster’s. Therefore, seek prompt medical attention. The treatment and billing records your doctors create will be the primary evidence substantiating your claim.
- The claimant did not see a company-approved doctor – Georgia law requires that you see a medical provider that has been approved by your employer or their insurer. A list of pre-approved providers should be posted at your workplace. Your claim will be denied if you do not see a doctor from this list.
How Can an Attorney Help?
Workers’ compensation claims can be highly technical and involve a lot of paperwork. Even a small mistake could result in your claim being denied. The best way to avoid complications is to get help from an experienced workers’ compensation lawyer as soon as possible.
If you were injured in a workplace accident, R. Alan Cleveland is here to help you maximize your workers’ compensation benefits. Our legal team will review your case, file all necessary paperwork, handle communication with adjusters, and help you in the event your claim is denied. Call us today for a free consultation or visit our contact page.
An Athens resident Alan Cleveland grew up in Rockdale County. As a founding partner of the personal injury law firm of R. Alan Cleveland, LLC he proudly serves his community and provides skilled representation to injury victims and their families all around Georgia. Alan earned his undergraduate degree from the University of Georgia and went on to graduate, summa cum laude, from Atlanta’s John Marshall Law School. He is also a graduate of Gerry Spence’s renowned Trial Lawyers College (TLC) in Wyoming. In his free time, Alan frequently speaks at continuing legal education seminars. He also volunteered as a youth baseball coach and assists with Georgia’s high school moot court competition held annually. Alan serves as a Trustee of Historic Athens and is a member of the Development Authority of the Unified Government of Athens-Clarke County.
