Dealing with Workers' Comp Claim Adjusters

There are so many parties involved in a workers' comp case and sometimes it's hard to keep track of who does what. Bilal and Carmen dive deep into the role of a claims adjuster within a workers' comp case. Learn what are some of the things that you should share and what you should not.
If you need help with your workers' comp case in CA. Call for a free legal consultation 800-606-6999. We would be more than happy to review your case. Did you know, that on average, injured workers' who hire a legal attorney receive up to 30% more benefits on a workers' comp claim.

[@cynthialynch9703]

As a claims examiner, I absolutely do care, and relate. Sometimes we are so overwhelmed with claims. We don't have secretary's, or assistance. Every thing is done by us. Including filling out state forms and documentation of state forms. We also need to fully investigate all claims. And ensure treatment and benefits are paid timely. We do everything we can to ensure a claim is reviewed and benefits paid if owed. I understand stand and relate to the injured worker.

[@Leea209]

Really ! Well my WC adjuster is different. My easy claim is going on for 2 months and still pending status! Because this adjuster sit on his ass! He never request medical records when he tells me he is waiting for medical records. Seriously , how can you expect something when you never requested. I have to wait in pain because of this lazy adjuster! HR is no help! Is there someone above the adjuster I can talk to.

[@benalexender3046]

Thanks ❤

[@blessedladyrobinson5674]

Is a claim manager for a self insured company the same as a adjuster?

[@cynthialynch9703]

Not to mention we need wage statements from employers to calculate average weekly wages. Things take time. But our main goal is to help. Please be patience.

[@WorkCompTalkPodcast]

Thank you for sharing your thoughts!

[@user-qx2db1sr8k]

I was batterd at walmartt and nobody nothing did anything about my TBI and neck injurys

[@venicemurillo8230]

I work for a surgeon who provide care for work comp patients. What should we do if adjusters take so much time to provide a determination letter? Some of the treatments requested are still pending for more than 2 months

[@WorkCompTalkPodcast]

Hi Venice, thanks for reaching out. There are many deadlines that are set within the workers' comp system. Unfortunately, many of those deadlines are used to the last second possible. We see this happening all of the time and it's frustrating. Keeping in contact with the Adjuster and calling in daily helps.

[@Leea209]

😂this mean … ain’t nobody can help!

[@samuelphillips6818]

talked with the adjuster who is handling my workers comp case about treatments not being given due to in process of settling 3ea. cases w/ different injury date- 1 question about this doctor is that he planned surgery thru out treatments because is was still treating for my other injury(surgery)-now that my other surgery was completed he omitted the surgery in his final report downing my pd rating. should i see a QME?

[@WorkCompTalkPodcast]

It's hard to say whether you should see a QME, normally we would want to see what your treating physician wrote in their report before going the QME route. A QME can be good, but can also be bad for your case if you don't end up with the right one, or you already have a really good report from your treating physician! Normally provision for future surgery would increase the value of your case. Sometimes it can impact the rating as well if the rating estimate is based on a type of surgery (for example, there is a fixed percentage rating for a total knee replacement with a good outcome). If your doctor did not write that in their report, but it was something you talked about, you could always ask about it at your next appointment. If you really don't like your treating physician, you can also switch. Just ask your adjuster for the MPN link and you can choose a new doctor. As long as you have future medical needs, they cannot decline this. Dealing with multiple dates of injury can be difficult, especially when there are overlapping body parts and/or liability issues. We typically don't recommend settling one case and leaving others if there is overlap. That being said, every case is different and recommendations are very fact dependent.

[@noninoni454]

My doctor and adjuster is pushing me to work light duty and I have only had 1 week of Physical Therapy and my doctor is also recommended surgery

[@WorkCompTalkPodcast]

This happens a lot. If you are not satisfied, know you have options! Wishing you the best of luck.

[@samuelphillips6818]

by the way --I do have an attorney but he is not returning my calls- i know it is too late in the came to fire this guy-- but how can i further my settlements (global) forward?

[@WorkCompTalkPodcast]

Sorry for the delayed reply! In CA you can always terminate your attorney, generally at any time you see fit. Whether it's a good idea is a different question depending upon how far along in the case you are. It would be difficult for us to give you suggestions on how to move your case forward without knowing much about what is going on. If you are concerned about the handling of your case, you can always consult with other attorneys. At the very least, maybe they can help you determine whether your attorney needs to be replaced. The WCAB also has information and assistance, which is a department that works with unrepresented individuals to help them work their way through the system without an attorney. They are kind of like the workers' comp version of public defenders in some sense. Best of luck to you!

[@jeannedosterwise8460]

So, my Workmans comp sent me for a second option I've been on workman's comp for 23 years She came back and said that I was unable to ever return to my Job she was a shrink and said going to training is a No too. What now I was not expecting that, and it was for my PTSD. not for the Physical injuries I also incurred during the accident However, when I showed the report to my Son in-law, he was upset his line of work is working with Behavior health Clients He said where's the Brain scan before handing out Drugs. I don't Do Drugs except one. . She the doctor said therapy heavy duty drugs when asked will it get better, she said NO so why take toxic drugs that will not help you. I would love to hear what you have to say. I see my pastor and talk to God Best FAITH How do I know here I am amen

[@WorkCompTalkPodcast]

Being on workers' comp for over 5 years is incredibly hard, we can just imagine what it's like being in it for 23 years. We do know the longer you are in it, the harder it gets to get anything approved and moved forward. Maybe it's time you seek help from somewhere or someone else? Wishing you the best of luck!

[@jeannedosterwise8460]

@@WorkCompTalkPodcast Just my luck, another dead end. Thank you so much for replying. Have a wonderful new year ... God Bless and keep you always amen.

[@billbandoh5818]

Mannn I’m dealing with a lazy adjuster and got approved for missed work. I’m calling this lady adjuster about my check and she says she doesn’t have a simple tracking number for me. How is that possible!

[@WorkCompTalkPodcast]

Yep, happens all the time. Keep your finger on it. There are penalties and sanctions you can get for late payments. It's in our next episode, make sure to tune in.

[@billbandoh5818]

@@WorkCompTalkPodcast will do. Saw a comment here that said go to the claims manager. Got the number and reported the issue. The adjuster sent me a tracking number 2 hours later !

[@samuelphillips6818]

can i fire my claim adjuster?

[@WorkCompTalkPodcast]

Hi Samuel, thank you for asking. Short answer is No. Unfortunately, you can't fire your claims adjuster, but if your claims adjuster isn't doing their job you can always ask to speak with the claims manager or supervisor and/or ask to have another adjuster assigned to your file. This would be discretionary though. Surgery can impact your permanent disability rating insofar as treatment can reduce your functional impairment or make it worse. Depending on who your treating physician is, you may get a better disability rating going to a QME. But you also risk getting a lower rating depending on which QME you end up with if you aren't careful.

[@mikesylvia7052]

First thing get yourself a good attorney

[@catieandthebopeeps]

Oh, I see. You delete my comment because it’s a conflict of interest for a claimant to see that adjusters actually do care. I can’t believe how shady that is.

[@realtalk37851]

Some adjusters may care but we all know what their job is so it's rare that you all do what's best for the injured worker.If that was the case then hearings wouldn't have to be scheduled as much as they are And people wouldn't need to hire attorneys as much as they do.

[@UberHaas]

Agreed, they do not care, plain and simple. Denying claims with absolutely no proof because I know where and what injuries occurred. 30 years if dealing with you pricks!!

[@UberHaas]

You don't care, trust me your assholes, all of you. My first Adjuster 30 years ago was aswome, but the last 3 have been un -willing to there job because they are denying medical claims that they claim happened in another accident and have not gotten those records, but I have and can prove they denied claims based off of no evidence!!

[@lauragrant2096]

We adjusters don’t get bonuses for any denials! Or settlements! We just are sick to death of the lying fake claimants when there are actual hurt people who need our help!