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Protecting the Rights of Injured Workers

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The claims adjuster’s role: know who you’re dealing with

On Behalf of | May 5, 2014 | Workers' Compensation |

A workers’ compensation claim does not involve a top-down process.

To be sure, the Colorado Division of Workers’ Compensation oversees the overall process. In practice, however, your dealings as an injured worker will more likely be not with a state bureaucrat, but with a claims investigator for your employer’s workers’ compensation insurance company.

In this post, we will consider what to expect from this investigator, who is commonly called a claims adjuster.

As with adjusters who handle other types of insurance claims, workers’ compensation adjusters work for the insurance company. Their job is to check out your claim, with an eye toward minimizing the amount of money that the company has to pay out on it.

Keep in mind, then, in all of your interactions with the adjuster, that the claims adjuster does not really have an interest in helping you. To the contrary: in terms of their professional role, claims adjusters could just as well be called claims minimizers.

Their job is to try to resolve your claim so that the insurance company will have to pay as little as possible.

Their role therefore requires adjusters to scrutinize workers’ comp claims closely to verify that coverage requirements are met. For example, an adjuster may question whether your injury really did occur on the job.

As we discussed in our March 12 post, an adjuster may also check closely to make sure that there is enough medical evidence to support your claim.

If there is any question about the evidence, it makes sense to have an attorney on your side to advocate for your rights. A claims adjuster will not do it for you.

To learn more about our firm’s practice, please visit our page on claims adjusters.

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