When an injured Arizona worker files a workers’ compensation claim with their employer, they expect that their company will do everything possible to deliver a positive result. However, what many people don’t realize is that it’s not their employer who pays out their workers’ comp benefits, but rather their employer’s insurance provider.
Like all insurers, workers’ comp insurance companies make more profit by paying out fewer claims—an incentive that puts the injured employee on the defensive and at a disadvantage. When the insurance company doesn’t make an effort to uphold the obligations associated with the contract that’s in place, then the insurer could be described as acting in “bad faith.”
A denial of your workers’ compensation claim could result in you paying out of pocket for medical expenses, lost wages, or other issues related to your injury. Unfortunately, there are numerous workers’ comp dirty tricks that insurance companies can use to delay, deny, or reduce claims.
While some of these tricks and tactics don’t actually constitute bad faith, you shouldn’t be fooled into falling for them. In this article, we’ll discuss some of the tactics insurers typically use and explain what you can do to avoid them so you can get the compensation you deserve.
In the meantime, if you need help with a workers’ comp claim in Phoenix, reach out to the skilled work injury lawyers at the Law Offices of Robert E. Wisniewski for a free consultation of your case.
What is an insurance claims adjuster?
A claims adjuster, or insurance adjuster, is hired by the insurance company to investigate a claim and determine whether the insurer needs to pay for damages. The insurance company can keep adjusters on its payroll or hire them from an outside contractor agency.
What does an insurance adjuster do?
An insurance adjuster performs multiple steps when assessing a claim, including:
- Reviewing the accident details
- Assessing the damage
- Looking at medical records
- Speaking to the injured party and witnesses
They then determine the amount of money the insurance company is potentially liable for.
Unfortunately, some insurance adjusters employ tricks to limit the amount of money the insurer has to pay you.
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What tactics do insurance adjusters use against injured workers to reduce or deny their claims?
Every injured worker should be aware of the dirty tricks adjusters use to try to take advantage of them before accepting a workers’ comp settlement offer. Below are just some of the ways adjusters try to cheat you out of the insurance settlement you need and deserve.
Avoiding your calls and emails to trigger your frustration
Understandably, after an injury, you want to get your questions answered, complete your insurance claim, and receive compensation as soon as possible. Adjusters may be very difficult to get on the phone and may not reply to emails either.
While adjusters work on multiple cases at once, their lack of responsive communication can be a strategy to increase your frustration. They hope you will give up if they don’t respond immediately. After waiting you out, they often try to make a lowball offer in hopes that you’ll accept any amount just to be done with the process.
Calling to offer “well wishes”
After a work-related accident, it’s common for insurance adjusters to contact injured workers under the guise of offering “well wishes” or gathering information for the claim. While this might seem like a kind and supportive gesture, these calls can sometimes be a strategic attempt to pressure you into settling for less than you deserve.
An agent may express sympathy and a desire to help, but their goal is often to secure a quick resolution that benefits the insurance company.
They might push for a settlement before you’ve had time to see a doctor or consult with an attorney about your rights. By doing so, they aim to avoid court proceedings and minimize the payout. It’s crucial to approach these conversations with caution and seek legal advice before making any decisions about your claim.
Insisting on recording your statement
A dirty trick some adjusters use is to tell you they need to record your statement. As long as you’ve been telling the truth, you may think you have nothing to hide. However, adjusters have many sneaky ways to take your words out of context and hurt your settlement through a recorded statement.
You might say, “I’m fine,” out of habit when the adjuster asks, “How are you feeling this morning?” They can use your response to make your injuries seem much less serious than they are in reality. Small mistakes or nuances in how you phrase your answer can cost you a lot of money on your claim, making it essential to get advice from an attorney on what not to say to a workers’ comp adjuster before giving a record statement.
Please be aware that you don’t have to consent to the recording. If an adjuster tries to bully you by insisting on a recording, you should consult a Phoenix work injury attorney, who can advise you on what to say (and not say) to the adjuster.
Pressuring you to sign an authorization for medical records
Insurance companies may pressure you to sign authorization forms shortly after your work-related injury, claiming it’s necessary to process your claim. While it’s true that you’ll need to provide certain medical information to support your case, signing a broad medical authorization—especially before consulting a doctor or an attorney—can lead to problems.
Adjusters may attempt to have you sign a blanket authorization, giving them access to your entire medical history. This allows them to comb through unrelated records, looking for pre-existing conditions or other factors to deny or reduce your claim. In some cases, they might even gather irrelevant personal information that could be used to challenge your eligibility for benefits or suspend your coverage entirely.
To protect yourself, never sign any authorization forms or share medical records with an adjuster without first seeking advice from an experienced workers’ compensation attorney. An attorney can ensure that only relevant information is shared and that your rights are fully protected throughout the process.
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Disputing medical care
Insurance companies may try to challenge your claim by asserting that certain treatments aren’t covered under your policy or by suggesting that you no longer need ongoing medical care after a limited number of doctor visits. If you follow their advice and stop seeing your doctor, it could severely harm your case. The insurer might use your decision as evidence to argue that your injuries aren’t as serious as you claimed, which could jeopardize your chances of receiving any compensation at all.
It’s essential to always follow your doctor’s orders regarding treatment and care, regardless of what an insurance adjuster suggests.
Ignoring medical advice not only puts your recovery at risk but also weakens your claim by creating the impression that your injuries aren’t legitimate or severe enough to warrant continued care.
An experienced workers’ compensation attorney can review the specifics of your case to determine if the insurance company’s tactics are legitimate or if they are simply trying to reduce or deny your benefits. If you’ve already had contact with the insurer, your attorney can evaluate the information shared and provide guidance to ensure your rights are protected. With legal support, you can focus on your recovery while your attorney handles the complexities of your claim.
Delaying payment of your claim
Insurance adjusters understand the financial strain you’re under after a work-related accident, and they may exploit that by using workers’ comp delay tactics to slow down payments on your claim. While you’re recovering and juggling mounting medical bills, household expenses, and lost income, they may use the delay as leverage to pressure you into accepting a low settlement.
If you’ve been out of work for more than 7 days, you’re entitled to start receiving wage loss benefits, which should continue monthly as long as you’re unable to work. Additionally, any medical treatments provided by an authorized treating physician should be fully covered by workers’ compensation, meaning you should never receive medical bills for these services.
So, what if my payments are delayed, I’m not receiving my wage loss benefits, or I’ve been billed for authorized medical care? If I have a problem, should I call my workers’ comp adjuster or an attorney?
You can always start with the insurance adjuster, but if they’re not responsive or they’re giving you the runaround, it may be time to talk with an attorney. Since an experienced work injury attorney is aware of the games workers’ comp adjusters play, they can work to ensure your rights are protected, hold the insurance company accountable, and secure the full compensation you’re entitled to.
Purposely not advising you of your legal rights
Insurance adjusters are not obligated to inform you of your legal rights, and in some cases, they may intentionally withhold important information to minimize the payout on your claim. It’s important to remember that adjusters work for the insurance company—not for you—and their goal is to protect the company’s bottom line, not your best interests.
They may lead you to believe that certain benefits, like mileage reimbursement for trips to medical appointments, are not covered when they actually are. Similarly, they might fail to mention that workers’ compensation can cover modifications to your home or vehicle if your injuries require them.
By keeping you in the dark, adjusters can steer you toward decisions that save the company money but leave you with fewer resources than you’re entitled to. This is why it’s critical to consult an experienced workers’ compensation attorney who can fully explain your rights and ensure you receive all the benefits you deserve.
Offering a quick settlement
After an accident, you may feel financial pressure to cover bills or pay for necessary medical treatments, but accepting the first settlement offer from an insurance company isn’t always in your best interest. Often, insurance adjusters will offer a low initial amount, hoping you’ll accept it quickly because you need the money. While this may provide short-term relief, it allows the insurance company to avoid court and significantly limits your compensation for future expenses.
Holding out and carefully evaluating your options can often lead to a better outcome. Many cases result in higher settlements when handled by an experienced workers’ compensation attorney, who can negotiate directly with the insurance company to secure the compensation you truly deserve. Before accepting any offer, consult with an attorney to ensure your long-term financial and medical needs are fully accounted for.
You need an attorney to help you fight back against insurance adjuster trickery
Dealing with an insurance adjuster on your own can not only be intimidating but also quite costly to your claim. The best move you can make after any serious work injury is to speak with an attorney about your workers’ comp case.
At the Law Offices of Robert E. Wisniewski, we’ve seen every tactic insurance adjusters use to minimize or deny workers’ compensation claims—and we know how to fight back. With more than 45 years of experience exclusively handling workers’ comp cases, our dedicated Phoenix work injury attorneys are proud to have helped countless injured Arizona workers secure the compensation they deserve.
When you need someone in your corner who truly understands the system, we’re here to stand up for your rights.
