Common Workers’ Comp Adjuster Tricks and Tactics

Workers' Compensation

Employees injured on the job have a right to workers’ compensation no matter whose fault the accident was. However, employers and the insurance carriers sometimes drag their feet, argue that the employee’s injuries are not that severe, or otherwise dispute the claim in order to save on costs. These include higher insurance premiums for the employer and lost finances for the insurance company.

Workers’ comp insurance adjusters, who evaluate each workers’ comp claim, can have a huge impact on whether or not you receive fair compensation. If your workers’ compensation claim has been denied, you believe that the benefits that you have been offered are less than what your injuries deserve, or your benefits were cut short, a Wisconsin workers’ comp lawyer can help.

Reducing Benefits Means The Insurance Company Saves Money

The workers’ compensation insurance industry has been, and continues to be, the most profitable insurance industry within casualty insurance, according to AmTrust Financial. As such, the workers’ compensation insurance industry is more profitable than both the homeowner’s/property insurance industry as well as the auto insurance industry.

How are such high profits possible? First of all, employers pay a relatively high monthly premium, which in reality comes out of each employee’s wages. Secondly, insurance companies pay relatively little when it comes to compensating injured workers. They do not have to cover the employee’s full lost wages, and other damages like pain and suffering are not included in a workers’ compensation claim.

This is unlike a personal injury claim filed after a car wreck, for example. To further reduce costs, workers’ comp insurance adjusters work diligently to devalue claims so that their companies can either pay less when it comes to wage replacement or medical services.

Top Six Tactics Used by Workers’ Comp Insurance Adjusters

The job of a workers’ comp insurance adjuster is to compile information about the claim such as:

  • How did the injury happen?
  • Where did it take place?
  • What was the diagnosis?
  • Does the insurance company have to pay out the claim under the regulations set forth by the Workers Compensation Act?

If the claim must be paid with the information the workers’ comp insurance adjuster gathers, the next step is to determine how much to pay and what benefits to pay. With the primary objective of paying as little as possible, there are plenty of tricks and tactics that workers’ comp insurance adjusters have when it comes to denying or settling claims. Adjusters are trained to attempt and force the hand of the injured worker, also known as you, to accept an offer that is less than you deserve.

  1. Delaying Approval—By simply delaying payment, a workers’ comp insurance adjuster hopes that you will simply give up, return to work, and end your attempts at seeking fair compensation for your injuries. After all, they know that you cannot afford to stay home from work without receiving your wages, especially if you have hospital bills to pay.
  2. Making a Quick, Low Offer—An insurance company can save time and money by quickly making a settlement offer that is far less than what they know you will be able to receive. In this case, the adjuster is simply hoping that you are desperate enough to take it without asking too many questions.
  3. Offering to Put You On Light-Duty Work—A doctor may clear you for light-duty work, such as working in the office instead of more intensive manual labor, even if you know that you cannot perform this job. An insurance adjuster will take this opportunity to offer you light-duty work and then deny your claim if you refuse. And, even if you accept to be put on light duty work, you may be suddenly taken off light duty before you are fully healed, and be expected to continue on with your normal duties as before.
  4. Putting You on Light-Duty That Is Not Actually Light—You may be put on light duty work, only to find that it is no such thing. In this case, you could lose your benefits simply by being tricked into a light-duty job that was anything but.
  5. Having a Private Investigator Trail You—Insurance companies go to great lengths to get out of paying what they owe, including hiring expensive private investigators to follow injured workers and take pictures of them. This can be at their home or about town, all in hopes of gathering information or pictures that seem to disprove or cast doubt on the severity of the worker’s injuries.
  6. Taking Your Statement—If an insurance adjuster wants to talk to you over the phone, they may try to have the conversation recorded. You are not required to give a recorded statement in Wisconsin. If you do though, anything you say can be used to devalue your claim, even if you said something that was taken out of context or stemming from confusion. It is not uncommon for an accident victim to have a hazy memory of the exact details concerning their accident, and a workers’ comp insurance adjuster will use this against them.

You Have a Legal Right to File a Workers’ Compensation Claim

In addition to the tactics used by workers’ comp insurance adjusters, you may also feel pressure from your employer to “stop complaining and just get back to work.” This pressure, in some cases, may come in the form of an actual or implied threat to fire you if you choose to file a workers’ compensation claim. However, Wisconsin law protects you from retaliatory termination such as this. Your employer cannot legally fire you for filing a workers’ comp claim. Furthermore, under 102.35(3), your employer cannot refuse to rehire you after being injured or filing a claim unless they have reasonable cause.

Call a Wisconsin Workers’ Comp Lawyer Today

If you were hurt on the job, denied benefits, or your benefits were suddenly cut short, you need to contact a Wisconsin workers’ compensation attorney to set things straight. Call the workers’ comp lawyers at Gillick, Wicht, Gillick & Graf today to schedule a free consultation.