When you are hurt on the job, you may be eligible to receive workers’ compensation, commonly referred to as workers’ comp. Workers’ comp is designed to pay for any medical bills and lost wages which may occur due to a work injury or illness. However, proving that an injury sustained in a work accident is eligible for workers’ comp can be difficult when unscrupulous insurance companies are involved.
In some cases, you may be eligible to file a personal injury claim in addition to a workers’ comp if the workers’ comp was insufficient to pay your injury-related expenses, or if the injury occurred due to another party’s negligence. However, these situations are not common and you should always file for workers’ comp before taking further legal action so you can begin to receive help with your medical bills and lost wages as soon as possible.
Insurance companies do not want to give their money away.
For this reason, many insurance companies will do everything in their power to dismiss your injury or disprove your claim. There are a variety of pitfalls to watch out for when dealing with a workers’ comp insurance company. Failing to be aware of and avoid these common missteps can result in a decrease or loss of workers’ compensation benefits.
Insurance Pitfalls to Watch Out for After a Work Accident:
- Thinking the insurance adjuster is on your side. While this would be ideal, it’s important to keep in mind that an adjuster’s job security and promotion rely on their ability to offer injured parties as little compensation as possible, or to avoid paying claims altogether in order to save their insurance company as much money as possible.
- Letting the adjuster record your statement about the accident. While it may seem reasonable for an insurance adjuster to record your statement regarding how the injury occurred, it’s wise to politely decline until you have spoken to an attorney, or at the very least to refuse the permission for them to record your statement.
- Admitting fault in the accident. This is related to allowing an adjuster to record your statement after the accident. It’s important to be careful about what you say to an insurance adjuster regarding the accident. Even making a blanket apology for the situation can be considered an admission of fault and could affect your eligibility for compensation. Even if you were partially or fully at fault for the accident, it’s important to speak to a lawyer before admitting this to an insurance adjuster.
- Letting the adjuster talk you out of an attorney. If an insurance adjuster tries to tell you that it is in your best interest to refrain from speaking to an attorney, or that speaking to an attorney could in any way affect your eligibility for compensation, it’s important that you ignore this advice and seek legal counsel regardless.
- Releasing your medical records to the insurance company. An insurance company may request a copy of your medical records to prove the injury you are seeking workers’ comp for. You do not have to release these records and should refrain from doing so before speaking to an attorney.
- Accepting money from the insurance adjuster in exchange for signing a release. Sometimes an adjuster may offer you a percentage of your claim right away in exchange for your signature on a release form. This often waives your right to the full compensation you would otherwise have been eligible for, and it is recommended that you refrain from accepting this partial payment and refrain from signing anything.
- Failing to pursue the issue when payment of your claim is delayed. Many insurance adjusters will delay paying a claim in the hope that the injured party simply will not pursue or press the issue. It’s important to consistently pursue your claim with an insurance company, and if delays continue, look into the possibility of filing an insurance bad faith claim.
- Allowing the insurance adjuster to decide what medical treatments are necessary. An insurance adjuster may try to imply that the medical treatment you received for your injuries is not necessary, therefore they do not need to pay the claim. Don’t let an insurance adjuster tell you what medical treatment is or isn’t necessary for your injuries.
- Letting the insurance company place the blame on you or a third party. Some insurance companies may try to tell you that they are not liable for your particular injury, and blame you or another party for the accident to avoid paying a claim. Seek legal counsel before letting an insurance company deny your claim based on these statements.
- Paying part of the settlement yourself outside of your contractual agreement. Some insurance adjusters may try to convince you to pay part of the settlement yourself outside of your contractual agreements. It’s important that you refuse to pay anything before seeking legal counsel.
- Failing to pursue a thorough investigation by the insurance company. It’s important that an insurance company perform a timely and thorough investigation of the accident. Failing or refusing to do so falls under insurance bad faith and may be an attempt to avoid paying your claim.
Many of these pitfalls fall under insurance bad faith practices.
Insurance bad faith occurs when an insurance company uses disreputable means to avoid or delay paying a valid claim; this is a serious accusation to make against an insurance company. The good news is that when an insurance company practices bad faith, there are signs you can watch for and often the mere mention of a suspicion of insurance bad faith is enough to set an adjuster straight. If this doesn’t appear to be effective, you can file an insurance bad faith complaint with the company and seek legal counsel from a workers’ comp lawyer to learn more about your rights and eligibility for compensation.
Written by AskTheLawyers.com on behalf of Sarah Stottlemyer with Stottlemyer & Associates.