Insurance Adjusters Are Highly Trained Adversaries

I have been representing injured workers against workers’ compensation insurance companies for the past 20 years. My office has handled hundreds (if not thousands) of cases during this time. By representing hundreds and hundreds of work accident victims over the years, I began to see how the insurance industry deals with victims after they begin the claim process following the work accident.

I know this is a bit long but I believe 100% that this is helpful information every injured worker in the State of Virginia needs to be aware of.  Pay close attention, this information is crucial!!!

Here are some questions that will make the insurance carrier know that you are well informed. Now, they don’t like it when you ask these questions because they either cannot answer the question or worse, they don’t want you to have the answer.

QUESTION 1: Isn’t it true that if I use an attorney, I’m likely to recover more benefits and more money in settlement than if I try to manage or settle the claim on my own?

ANSWER: Don’t be surprised if the adjuster lies to you and says “no” to this important question. How do I know the answer is false? Because a study by the Insurance Research Council (a nonprofit group funded by major insurance companies across the nation) found that the average total payout on claims that have an attorney involved is 4.8 times greater than those claims where the injured victim settled on his or her own. This same study showed that individuals who use an attorney receive 3.28 times more money after the attorney’s fee is paid. Most insurance claims adjusters are very aware of this study. So, if the insurance company wants to maximize profits it will train its claims representatives to go to great efforts to dissuade people from hiring an attorney. Simply put, the insurance companies know that if you hire counsel you will likely get more money in settlement, even after deducting the lawyer’s fee. Second, since in workers’ compensation the injured worker has the burden of proof, they are not obligated to tell you if there are any additional benefits you could be receiving. Rarely have I had someone come to me who knew all of the benefits for which they were entitled from their insurance adjuster.

QUESTION 2: How can the insurance company verify that the settlement amount (or the allowed calculation or impairment rating, etc.) being offered to me is fair and reasonable?

ANSWER: It can’t and it won’t. Sure, the adjuster will tell you that the settlement offer is reasonable and fair but he can’t verify or prove to you that everyone with similar injuries never receives more. Unless you are in the business of negotiating and settling injury claims, there is little chance you will know whether the settlement amount that is being offered is fair. Therefore, by negotiating and settling the claim yourself without using the assistance of a professional, (i.e., a workers’ compensation attorney), you run the risk of accepting a sum that may turn out to be much less than what is considered reasonable for your type of claim.

QUESTION 3: Why do I have to give you a recorded statement when you can get information about the accident from the First Report of Injury?

ANSWER: Because the insurance company will try to use your own statements against you! In most accidents, a First Report of Injury form will be filed and the insurance company has easy access to this report (it just takes a phone call to your employer). So why is a recorded statement necessary? Most companies have written policies in place which require the adjuster to get a recorded statement to see if there’s any information the accident victim might reveal which could be later used to either deny the claim or pay out less money.

QUESTION 4: If I give you a recorded statement, can I then get a recorded statement from your own insured, i.e., your employer, supervisor, or co-workers?

ANSWER: No! This will never happen. It seems fair though, doesn’t it? If you have to give a recorded statement about the accident, then why can’t you also get a statement from the other individuals involved? Yet, the insurance adjuster will never allow this for the same reasons you should never give a recorded statement to the insurance company.

QUESTION 5: Why do I have to give you an unrestricted medical authorization before I can get any medical treatment?

ANSWER: So the adjuster can go fishing into your past medical history and find anything about your prior health which will help the company either deny your claim or pay out as little as possible. You can just as easily collect your accident related records and send them to the carrier for its review. However, usually, if you are not represented by counsel, the carrier will never accept this. By using an attorney, the attorney can usually put a few limits on how much medical information needs to be disclosed. There is no doctor/patient privilege in a workers’ compensation case, so they can get any medical records but an attorney can help steer them in the right direction.

QUESTION 6: Shouldn’t I wait until my medical status is stabilized to settle the claim?

ANSWER: Yes, because the insurance company knows that the quicker you settle the claim the less money it will have to pay out. Once you settle the claim you can’t reopen the case if it turns out your injuries are more severe or if you need more treatment as recommended by your doctor.

QUESTION 7: Why haven’t you told me about mileage reimbursement, COLA (cost of living adjustments), or other benefits?

ANSWER: Probably because they don’t have to. The injured workers have the burden to prove their case. The insurance company can sit back and do nothing. They probably have a don’t ask, don’t tell policy to save their company money. If you do not independently find out about your benefits, the insurance adjuster will not tell you.

 QUESTION 8: If you are claiming that my medical treatment is unreasonable, will you pay my doctor to write a detailed report explaining why my treatment has been reasonable, necessary and related to the work accident?

ANSWER: Of course not! The insurance company will always refuse this request. Although the claims adjuster has absolutely no medical training, nothing stops him or her from arguing that your treatment was excessive or unreasonable. This is just one way the insurance carrier will whittle down your claim. An experienced workers’ compensation attorney on your side will solve the problem!

QUESTION 9: Why didn’t you tell me to file a Claim Form with the Virginia Workers’ Compensation Commission? (even if you are making voluntary payments.)

ANSWER: In Virginia, you only have 2 years from the date of the accident to file your Claim Form against your employer. This is also called the statute of limitations. Sometimes, the workers’ compensation insurance company will intentionally delay and drag out the process or make voluntary payments. Then, before you know it, the 2 year statute of limitations is right around the corner. The insurance company knows that you only have a certain amount of time to file your claim and if you’re backed up against the statue of limitations, there is a good chance no reasonably good attorney will take your case. You will then be forced to accept a settlement that is virtually pennies on the dollar of the true value of what the claim is worth or receive nothing further at all. The insurance company making voluntary payments is not the same thing as filing a Claim Form with the Virginia Workers’ Compensation Commission which ensures your rights. The reason to file your claim with the Virginia Workers’ Compensation Commission is to get an award order. The award order indicates that the insurance company is legally obligated on your claim, that you are entitled to lifetime medical benefits, and details the facts of other benefits if you are entitled to other benefits,

There you have it – insurance adjusters are well trained in the art of misinformation.  DON’T BE TAKE ADVANTAGE OF!!!  Take a stand by educating yourself to ensure NO ONE is able to pull the wool over your eyes!

Check out the next posts for more tips to shed some light on the misinformation adjusters give to injured workers.  It could mean the difference as to whether or not you are awarded benefits for your work injury!

If you would like more information on the Virginia workers’ compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia,” or call our office today (804) 755-7755.

~Author

Michele Lewane, Esq.