What is a Work Comp. Claims Adjuster?

There are many components to a Work Comp. case, as well as many players involved. Attorneys, judges, employers, and employees. However, there is another important person involved in Work Comp. cases, and that is the claims adjuster.

So, what is a claims adjuster?

A claims adjuster investigates workers’ compensation claims to determine whether the claimant can legally receive compensation. They work with the injured worker, their employer, and the insurance company to protect everyone’s interests. However, the ultimate goal of a claims adjuster it to bring the file to closure as quickly and cheaply as possible, to protect the insurance company.

What are usually an adjuster’s job duties?

- Determining if your claim will be accepted or rejected

- Approving medical care, and various forms of treatment or surgeries

- Coordinating medical appointments with doctors

- Gathering information from the employer about what happened

- Discussing settlement options and deciding how much your case is worth

Adjusters will ask for a recorded statement after you report a claim/injury. The adjuster will ask permission to record the statement that you are about to give, and then will ask a series of questions about the claim that you are making. Generally, injured workers should speak to an attorney prior to allowing a recorded statement to be taken. Often, these statements are used to deny the claim at a later date. These recorded statements start the investigation into your claim and all prior medical history, prior accidents and prior injuries. If an injured worker fails to respond accurately, that may be a basis for a denial of the claim.

For example: How did the injury occur? Did you go see the doctor right away? Did anyone see what happened? What kind of medical care are you getting? What were you doing right before the injury?

Additionally, in order to know if the claims adjuster you are working with knows what they are doing, there are some signs to look for.

Signs of a good claims adjuster:

- Contacts the claimant and employer as soon as possible

- Communicates in a timely matter, adding a personal touch by making all parties feel as if their concerns are heard and understood

- They review all information carefully and make sure all relevant medical and financial documents are gathered to make the process as smooth as possible

I hope you have found this information useful. Please do not hesitate to contact our office to schedule your free consultation with Marcie Baker if you feel that you or someone that you know has a Workers’ Comp. claim.

***The information contained in this blog is meant to be informational only and in no way constitutes legal advice of any form. Should you have any questions regarding a Work Comp. claim of you or someone you know, please reach out to our office.

Sources: 

https://www.gilbertsrisksolutions.com/importance-claims-adjuster/#:~:text=Basically%2C%20a%20claims%20adjuster%20investigates,company%20to%20protect%20everyone's%20interests

https://www.krasnolaw.com/blog/workers-comp-claims-adjuster