The Confidential Conundrum: Navigating Privileged Discussions In Workers' Compensation Claims

After an injury at work, you will likely be contacted by an insurance adjuster, also known as a case manager or claims manager. The adjuster works for the workers' compensation insurance company and their primary goal is to minimise the amount of money the insurance company will pay out. They are highly trained and will use various tricks to achieve this goal. For example, they may ask for a recorded statement, which they can use to twist your words and make your injury sound less severe than it is. They may also try to get you to speculate or guess, fish for pre-existing conditions, or offer a lowball settlement. It is important to remember that you do not have to speak to the adjuster and that they are not on your side.

Recorded statements: You are not obligated to provide one, and adjusters may use them to elicit information to reduce or deny your claim

After a workplace injury, you will likely be contacted by an insurance adjuster, who will ask you to provide a recorded statement. However, it is important to remember that you are not obligated to give a recorded statement, and it is generally not advisable to do so.

The insurance adjuster works for the insurance company, and their goal is to minimise the amount of money the company will have to pay out. They are highly trained and will use various tactics to try to get you to say something that can be used to reduce or deny your claim. For example, they may ask leading questions or try to get you to speculate or provide opinions. They may also use your statement to argue that your injuries are not as severe as claimed or that they are related to a pre-existing condition.

If you do decide to give a recorded statement, it is important to be careful and stick to the facts. Be aware that anything you say may be used against you, and do not feel pressured to provide information that you are uncomfortable with disclosing. It is also a good idea to consult with an attorney before giving a statement, as they can advise you on how to protect your claim.

In summary, while it may seem harmless to provide a recorded statement to an insurance adjuster, it is important to remember that you are not required to do so. Adjusters may use your statement to reduce or deny your claim, so it is generally in your best interest to decline their request. If you do choose to give a statement, be cautious about what you say and consider seeking legal advice first.

Medical history: Adjusters will ask for a blanket authorization to review your full medical history. They use this to talk to doctors and fish for pre-existing conditions

When you file a workers' compensation claim, the insurance adjuster will often ask you to sign a blanket medical authorization form. This is a form that allows the insurance company to access your medical records. While this may seem like a formality, it is important to remember that the adjuster is not on your side and is looking for ways to reduce the value of your claim.

The insurance company is entitled to review certain medical records to verify that your injury is legitimate. However, they often ask for a "blanket" authorization to review your full medical history, which gives them access to information that is not relevant to your claim.

The adjuster will use your medical history to try to talk to your doctors without your presence. They may attempt to influence your doctor's recommendations, such as pressuring them to return you to unrestricted work. They will also look for any pre-existing conditions that could suggest that your injury was caused by something else. For example, if you have a history of mental health problems, they may try to argue that your injury is related to symptom exaggeration or malingering.

You do not need to give the insurance company unrestricted access to your medical history. You can ask them to specify what information they need and carefully examine any medical authorization form before signing. Alternatively, you can let an experienced workers' compensation attorney handle this for you.

It is important to remember that you are not required to sign a blank medical authorization form to receive workers' compensation benefits. In some states, such as Georgia, you must provide a certain type of medical authorization when requested. However, you should only sign forms that designate the specific medical providers who have provided treatment for your injury.

If you have a pre-existing condition, it is important to be honest about it. In most states, you are still eligible for workers' compensation benefits if your work injury aggravates a pre-existing condition. However, the insurance company may try to use this information to deny your claim or reduce the value of your settlement.

To build a strong claim, it is important to file your claim right away and be detailed and specific about your injury and symptoms. Seek prompt medical care and consistently report your condition to all medical providers. This will help improve the chances of reaching a consensus among the doctors involved in your claim.

Independent medical examinations: The insurance company can require you to submit to an IME by a physician of their choosing, who will provide a second opinion

When you file a workers' compensation claim, there is a chance that your employer's insurance company will disagree with your treating doctor's decisions about your course of medical treatment, the extent of any permanent disability, or the causal relationship between your job and your condition. In such cases, the insurance company may require you to submit to an independent medical examination (IME) by a physician of their choosing. An IME is meant to provide a neutral, second opinion about your medical condition and resolve any disputes.

The process of choosing an IME doctor varies and may affect the objectivity of their assessment. In some states, the insurance company selects the IME doctor, while in others, the doctor is randomly chosen from a list, or designated by a judge. Since IME doctors are paid by the insurer, they may have an incentive to produce opinions that favour the insurance company, which could encourage the insurer to continue using their services. Therefore, the neutrality of IME doctors is questionable.

Before the examination, the IME doctor will receive your medical records and any other relevant documents related to your injuries. The insurance company may also send a letter to the IME doctor, highlighting specific issues in dispute, such as causation, the accuracy of the treating doctor's diagnosis, the necessary treatment, your ability to return to work, and the duration and extent of any disability. You have the right to review and correct any mistakes in this letter.

During the IME, the doctor will review your medical history, conduct an interview, and perform a physical examination. They may ask about your past and present medical and work history, the cause of your injury or condition, how it affects you currently, and any treatment you have received or are considering. It is important to cooperate and be straightforward and clear in your responses. Remember that IME doctors are not able to provide you with medical advice or opinions about your treatment.

After the IME, the doctor will produce a report based on the interview, examination, and the information provided. This report may significantly impact your workers' compensation case and how much you receive in benefits, as judges often view IME doctors as experts. If you disagree with the findings, you can challenge the report and, in some states, request a second IME performed by a doctor of your choice.

Pre-existing conditions: Adjusters will try to blame your injury on a pre-existing condition, even though this does not mean you are ineligible for benefits

When making a workers' compensation claim, it is important to remember that the insurance adjuster is not on your side. They work for the insurance company and their goal is to save the company money by finding ways to terminate your claim as cheaply as possible. One of the tricks they may use is to blame your injury on a pre-existing condition. However, this does not mean that you are ineligible for benefits.

A pre-existing condition is simply one that you had before your accident. It could be a previous injury or a chronic illness. If your pre-existing condition has been worsened by an accident, you can still claim compensation. To make a claim, you must demonstrate that the third party is liable for the accident and should have avoided it. If you can prove liability, you can claim compensation on a no-win, no-fee basis.

When dealing with insurance adjusters, it is important to be cautious and not believe that they are your friend. They are trained to ask leading questions and get you to lower your guard. They may try to get you to admit that your injury is related to a pre-existing condition, even if it is not true. It is crucial that you do not provide a recorded statement to the adjuster, as you are not obligated to do so. You should also be careful not to sign any blank medical authorization forms, as this gives them access to your full medical history.

Instead, you should consult with an experienced workers' compensation attorney who can guide you through the process and protect your rights. They can help you separate your new injuries from any pre-existing conditions and ensure that you receive fair compensation. Remember, you have the right to fair compensation, regardless of your medical history.

Lowball settlement offers: Adjusters know you're in a tough spot and may try to settle your claim for less than it's worth

When dealing with insurance adjusters, it's important to remember that they are not on your side. Their primary goal is to minimise the amount of money the insurance company will pay out. This means that they may use various tactics to try to settle your claim for less than it's worth. Here are some things to watch out for:

• Quick settlement offers: If you receive a settlement offer soon after your accident, it's likely to be a lowball figure. Insurance companies know that you may be desperate for money to cover your medical bills and other expenses, and they will try to take advantage of this. Don't let them pressure you into accepting an offer that's too low.
• Pressure to accept: Insurance companies often try to push for a quick settlement because they know that the longer the process takes, the more likely you are to consult a lawyer. They may imply that their offer is as high as it will go and that you need to accept it fast. Don't fall for this tactic. You have the right to take your time and consult a lawyer before accepting any settlement.
• Ignoring or dismissing evidence: Insurance companies may try to downplay your injuries or claim that they were caused by a pre-existing condition. They may also argue that you were at fault for the accident, even if there is evidence to the contrary. Don't let them get away with this. Gather all the evidence you can, including medical records, police reports, witness statements, and photos or videos of your injuries. This will help you prove that your injuries are legitimate and that you deserve compensation.
• Questioning your injuries: Insurance adjusters may try to imply that your injuries aren't as serious as you claim or that they were from a pre-existing condition. Don't let them get away with this. Get copies of your medical records and ask your doctor to provide a statement confirming that your injuries were caused by the accident.
• Not explaining the maths: You have the right to know how the insurance adjuster arrived at their settlement amount, especially for emotional damages. If they can't give you a straight answer, it's likely that they are lowballing you.
• Going silent: Sometimes, insurance companies will stop responding to your calls or emails. They know that this will create anxiety and make you more likely to accept a lowball offer. Don't fall for this tactic. Continue to reach out and assert your right to a fair settlement.

Remember, you don't have to accept a lowball settlement offer. You have the right to negotiate for a higher amount and, if necessary, take legal action to get the compensation you deserve.

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