Should I Speak to the Workers’ Comp. Claims Adjuster in Massachusetts

Getting money through workers’ compensation can sometimes be challenging.  Not only will you have to deal with your employer, but you will also have to deal with their insurance company.  Even if your employer wants you to get the benefits you deserve – which is not necessarily common – their insurance company often has a profit incentive to avoid payouts.  When speaking with a workers’ comp. claims adjuster, it is important to get legal advice first.

You should avoid speaking to any insurance adjusters without your lawyer present.  The claims adjuster could be trying to get information from you that would help them deny your claim, such as any indication that the injury happened outside of work.  Without having a lawyer present, you might say things that could hurt your case, even if you are well-meaning.

For help with your workers’ compensation case, contact our Massachusetts workers’ compensation attorneys today.  Never try to negotiate these cases on your own without calling the Law Office of John J. Sheehan for a free case review at (617) 925-6407.

Can I Talk to the Workers’ Comp. Insurance Company Without a Lawyer?

In many cases involving insurance claims, injury victims believe they can handle the case without a lawyer.  After all, the whole purpose of insurance is to prevent people from having to go to court to get the compensation they need.  If you can avoid court, you can avoid working with a lawyer, right?  In many cases, this is not actually a good decision, and you should often lawyer up before speaking with workers’ compensation insurance representatives.

The goal of insurance adjusters is usually to resolve the claim as cheaply as they can.  For most claims, the cheapest resolution would be to deny the claim entirely.  Insurance companies can’t just do this because they must act in good faith to try to follow the rules of their own insurance policies.  These policies usually dictate that they have to cover any accidents that happened at work, regardless of who was at fault.  But that doesn’t mean that they will always accept your word on the matter and pay the claim without a hassle.

In many workers’ comp. cases, the insurance adjuster will be looking for excuses to deny your claim.  that means any technical issues, such as missing information or missed filing deadlines, could end your case.  it also means that any indication that the injury happened outside of work or that there was a delay in reporting the accident could be used against you.

Even if you are totally well-meaning, the insurance representative might try to use your words against you.  For this reason alone, you should never go into insurance negotiations without at least speaking with a Wakefield workers’ compensation attorney first.  In many cases, your attorney can even handle these negotiations or questions for you, or they can at least be present or on the phone with you during these discussions.

Information that Can Ruin a Workers’ Compensation Claim in Massachusetts

As mentioned, insurance claims adjusters will often look for any information they can use to deny a claim.  In workers’ compensation cases, this often means zeroing in on the information that indicates that the injury is ineligible for workers’ compensation, usually for one of the following reasons:

Injuries Outside of Work

If the insurance company can use your own words and statements to claim that the accident or injury happened outside of work, they can try to deny your claim.  In most cases, no injured worker claiming workers’ comp. benefits is going to say that the injury happened outside of work.  that would mean having their claim immediately denied (and it could be insurance fraud).  Instead, the insurance company is going to look for any details that do not match up or facts that call into question whether your accident actually happened at work.

If the insurance company can so much as say they aren’t sure that your accident happened at work, they can often deny the initial claim.  In many cases, providing additional information can help lock down the facts and show your accident did indeed happen at work.  However, that could mean having your case denied and then appealing it later.  it is better to work with a Cambridge workers’ compensation attorney to prevent these miscommunications in the first place.

Injuries Not Reported on Time

If your injuries were not reported right away after the accident, the insurance company can try to claim that that missing time is suspicious.  Like with the last issue, the insurance company could say that failing to report the injuries on time makes it hard to confirm when they actually happened and that they did actually happen at work.

If there are any gaps in your facts, the insurance company could use them to deny your claim.  Your workers’ comp. lawyer can ensure that the information provided is full and complete, and that any gaps in information or missing time can be explained through documented reports and records of medical treatment.

Problems with Claims

If the insurance company can point to any technical errors with the claim, they can deny your claim.  Even something as simple as your name not exactly matching their records or your employment records can be an issue.  Many workers might not know that using a nickname or failing to include your middle name on the forms could result in claim denials.  Similarly, turning in the wrong forms or not signing forms in the right place can also create issues or delays.

Your Malden workers’ compensation attorney can help ensure that your forms are full and complete to avoid these kinds of technical issues.  and if the insurance adjuster reaches out to you with any potential issues or questions, your attorney can help resolve these issues as soon as possible and correct any missing information, ideally avoiding a denial.

Call Our Massachusetts Workers’ Compensation Attorneys Today

If you were hurt at work and are looking to file an insurance claim, work with an experienced Somerville workers’ compensation attorney like those at the Law Office of John J. Sheehan.  Call our offices today at (617) 925-6407 for a free case review instead of trying to handle any insurance adjusters’ questions on your own.