10 Factors The Insurance Adjuster Uses To Evaluate Your Workers’ Compensation Claim

1) Whether You Are Represented by An Attorney

            An insurance adjuster views an unrepresented party as an opportunity to settle a claim below its full value. Someone who is not an attorney, specifically an attorney who has spent years practicing workers’ compensation law, doesn’t know the ins and outs of the law and likely doesn’t know how to or have the adequate experience to know what the true value of their claim is. It takes an attorney years of practicing to know how to get full value for a claim. Statistics show that insurers pay out 2.7 times more on claims when there is an attorney involved. So, if you crunch the numbers and do the math, you are going to put more money in your pocket when an attorney represents you.

2) Whether You Are Represented by An Experienced Attorney

            Insurance companies will also look at who the attorney is on the claim. Not all attorneys are created equal. An attorney who doesn’t have a track record and representation of trying workers’ compensation claims before the South Carolina Workers’ Compensation Commission are at a disadvantage compared to an attorney with a track record of good results. Insurance companies to keep databases of attorney’s and track their reputation on handling claims. So, you not only need an attorney on your side but you need an experienced attorney on your side.

3) Whether You Have Ever Had Any Preexisting Claims Or Injuries

            Insurance companies have an abundance of resources to fully investigate claimants and their background. Part of this investigation is searching national databases and software applications that allows them to determine if you have ever filed any prior workers’ compensation claims or suffered any prior on-the-job injuries. If insurance companies find that a claimant has an extensive history of filing worker’s compensation claims with prior employers’, they will use this information to their advantage in attaching the claimant’s credibility or, possibly, the entire compensability of the claim.

4) Your Character Evidence

            Another part of the insurance company’s investigation involves researching your general background information and history. This includes your criminal record, prior medical history, prior work history including any terminations, prior insurance claims, family history, social media accounts, driving record, etc. Any negative information that the insurance company finds will be used as leverage to the their advantage in attaching a claimant’s credibility.

5) Desperation and Delay

            If an insurance adjuster senses that a claimant is in desperate need of money they will strategically offer an initial low amount in hopes that the injured worker will accept the quick offer. In the event this offer is denied, the next step by the adjuster is to delay any additional offer in hopes that the claimant becomes desperate to settle over time.  An attorney may be able to help you secure additional means of income if you are unable to work while your claim is being litigated.

6) Sending You To Favorable Doctors

            Under South Carolina law, your employer has the right to control your medical treatment during the course of a workers’ compensation claim. This means that your employer, or more accurately their workers’ compensation insurance carrier, has the right to choose what doctor they will send you to for treatment. The overall value of your claim will largely depend on your doctor’s opinions. Specifically, what type of work restrictions your doctor places you on, what type of future medical treatment they recommend and any actually impairment rating they assign as a result of your injury. Insurance companies know who the most conservative physicians in your area are, and often use the same doctors to send workers’ compensation patients to in hopes of receiving favorable opinions. These physicians may assign lower rating favorable to the insurance company’s position. An experienced worker’s compensation attorney can help control your medical treatment, help you secure a second opinion from a different doctor and even send you for an independent medical exam with a doctor of your choosing.

7) Surveillance

            Insurance companies will do a thorough investigation into your claim, especially if they believe you are untruthful or exacerbating your injuries. This will include searching and canvassing any social media accounts you or any relatives might have to find any information to use against you. This will also include hiring private investigators to follow you and conduct videotaped surveillance. The goal is to try to catch you performing acts that are inconsistent with you medical treatment and your explanation of the severity of your injuries.            

8) Light Duty Accommodations

            If your doctor places you on light duty work restrictions and your employer has work within your restrictions, you will have no choice but to perform the work that is offered. However, often times employers will develop new positions for claimants just to have them show up to work so that they can avoid paying wage benefits. This can include simply having a claimant sit at a desk all day and review documents or even finding a job with a completely different employer who might have work within your restrictions. Again, if your employer provides work within your restrictions you will need to work, but you still need to ensure you are receiving your same pre-injury rate of pay and wages.

9) Requesting An Employment Resignation

            Insurance adjusters will often times try to convince an injured claimant in resigning from their job in order for them to settle their claim. There is no law in South Carolina that requires an injured worker to resign from their job in order to settle their workers’ compensation claim. With that said, there are times when a claimant is assigned permanent work restrictions and might not be able to continue in their previous position. In this instance, an employee resignation might be moot. However, you need to make sure you are aware of what rights you are waiving before signing any documents. An experienced workers’ compensation attorney can help you with these issues.

10) Forcing You To A Hearing

            In the event you cannot reach a settlement with the adjuster, they will often file a claim for a hearing with the South Carolina Workers’ Compensation Commission to ask a Commissioner to decide what is owed. The adjuster will then send the file to an attorney who will appear on behalf of the insurance company to represent their position at the hearing. This will require the claimant to either proceed to the hearing and represent himself or herself against an attorney (an obvious disadvantage), or require them to hire an attorney who will appear at the hearing on their behalf.

Speak with An Experienced Workers’ Compensation Attorney

            If you have been injured on the job and are seeking a workers’ compensation attorney in Charleston, SC, please feel free to contact the Law Office of Jared C. Williams, LLC at (843) 991-6528 to speak with our attorney about your claim. We are always happy to see if we can help with any issues you might have.

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