When you file a workers’ compensation claim with your employer, you are likely to quickly hear from an insurance adjuster from the company representing your employer. Unfortunately, no matter how helpful they may seem, representatives from the insurance company are not on your side. As a result, you should understand their role in your claim before you attend a meeting with insurance companies during a Wakefield worker’s compensation claim.
The goal of an insurance company is to maximize profits by paying out as little as possible on insurance claims. Therefore, insurance adjusters routinely deny even valid claims in hopes of reducing their financial responsibility. A workers’ compensation lawyer can help shield you from the profit-motivated tactics of the insurance company and work to obtain the benefits that you need.
Reporting Workers’ Compensation Claims to Insurance Companies
After employees report a work-related illness or injury to their employers, state law requires the employers to report the claims to their insurance companies within seven days. The insurance company then has 14 days in which to deny or approve the claim for benefits. Due to these deadlines, workers can expect to hear from the insurance company right away.
The insurance company would typically want to take a recorded statement from the claimant, whether by phone or in person. The stated purpose of this statement is for the insurance company to learn more about the claim to evaluate it properly. However, the company is also likely interested in gaining information that may allow them to reduce or deny payment to the worker.
Some of the factors that an insurance company representative may explore during a recorded statement that might affect their coverage and decisions about a claim include:
- Preexisting medical conditions
- An urgent financial need that may cause claimants to accept a lower settlement
- Your reliability as a potential witness
- Other information not relevant to your claim, such as private medical insurance coverage
In its haste to meet required deadlines, insurance companies often pressure injured workers to make ill-advised, uninformed, or simply incorrect decisions. Therefore, getting legal representation for a Wakefield Worker’s Compensation claim and meeting with insurance companies may be wise.
Protecting Rights When Speaking with Insurance Companies
When individuals are speaking with insurance companies about their workers’ compensation claims, they must take care to protect their rights to compensation. Otherwise, they risk receiving a decision from the insurance company that reduces or denies their available benefits.
For instance, workers should take care to speak as precisely as possible about their injuries. Rather than speaking in generalities, employees should be extremely detailed and specific about how and where their injuries occurred. They should also give concrete examples about their level of pain or impairment and how the injury affects their daily activities, in addition to their work duties.
Workers should also be consistent in their statements about all aspects of their claim. Insurance companies tend to look for inconsistencies in employee statements, which they then use to undermine the credibility of the employee. This tactic often leads to denied or reduced claims.
Medical Authorizations and Workers’ Compensation Claims
In the context of insurance companies meetings during a Wakefield Worker’s Compensation claim, insurance adjustors may ask employees to sign a general medical records release. Individuals should avoid signing a general release, as their preexisting medical conditions and mental health records are not relevant to the pending workers’ compensation claim.
Workers should limit release forms to those that request medical records from on or after the accident or injury date. Otherwise, workers risk giving insurance companies unnecessary information that may adversely affect their workers’ compensation claims.
Wakefield Worker’s Compensation Claim and Insurance Companies Meeting
Meeting with insurance companies during a Wakefield Worker’s Compensation claim can be a stressful and overwhelming experience. Especially when you are dealing with a severe injury and working to recover, having a workers’ compensation attorney at your side may be critical to a successful meeting and claim.
Insurance companies often resort to underhanded tactics to undermine your claim, including obtaining information not relevant to your injury and even conducting surveillance on you. Avoid these scenarios by getting the legal advice that you need to strengthen your claim for benefits.