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How to Deal with a Workers' Comp Adjuster

If you are involved in a workplace injury and file for workers’ compensation, you’ll be contacted by an adjuster working for your employer’s insurance company. This individual might not actually refer to themselves as an adjuster, but might use an alternative title such as “case manager” or simply say they’re a representative of the insurance company.

You may receive a letter, phone call, or (most likely) both from the workers’ comp adjuster. In these communications, the adjuster will ask you to provide information about your injury. They’ll probably also want you to sign documents that release your medical records and other sensitive information to the workers’ comp insurance company.

If you’re never dealt with a workers’ comp claim before, you’re probably wondering what you’re really obligated to do in this situation. Let’s get into some of the ways you can deal with a workers’ comp adjuster.

Can I Trust an Insurance Adjuster?

No, but only because this individual works for the workers’ compensation insurance company. Their role is to protect the insurance company’s revenue by limiting what it has to pay out for a claim or preventing a payout altogether.

The adjuster may seem like a nice person – and very well could be outside of working for the insurance company – but you must be cautious whenever you’re speaking to this person and be mindful of what you say. When this person is investigating your claim, they are not your friend and certainly not on your side.

Do I Have to Give a Recorded Statement to a Workers’ Comp Adjuster?

Under no circumstances are you obligated to provide a recorded statement to a workers’ comp adjuster. In fact, you don’t even need to speak with this person at all.

Once again, the adjuster’s job is to investigate your claim and look for every possible reason to deny it or limit it as much as possible. In most cases, that decision also lays with the adjuster. Failing to provide the adjuster with a statement could result in a denial of your claim, but keep in mind that any information you give can also be used to the same effect.

If that feels like a bit of a Catch-22, well, it is. There’s a risk in both providing and not providing a statement, so if you decide to give one, be sure to carefully provide your answers, don’t leave any important details out, and don’t let the adjuster trip you up.

The Adjuster Sent Me Forms – Which Ones Do I Have to Sign?

If you receive any paperwork from the adjuster, carefully read through it before signing anything. You may even want to consult a workers’ comp attorney to help you review these documents.

In most cases, you’ll receive a medical authorization form. Signing this document allows your doctor to release your medical records to the workers’ compensation insurance company. A medical release may not just cover your current doctor, but any you’ve seen within a certain span of time in the past. What the insurance company is looking for is information about a possible pre-existing condition or previous injury that could be used to limit or deny your claim.

In California, pursuing your workers’ compensation claim will require you to release relevant medical records to the insurance company. The keyword here, though, is “relevant.” Not every medical record is relevant to your injury, so a blank medical release form may be totally inappropriate. The best way to handle this is to consult with a workers’ comp attorney who can help you avoid unintentionally sabotaging your claim by falling for one of the insurance company’s tricks.

At Smolich and Smolich, we can provide the legal guidance people need to facilitate their workers’ compensation claims. We’ll help you deal with adjusters and advise you of what you should or must do during this delicate process.

For more information about how we can help, please contact us online or call (916) 571-0400 today.