Why That First Call Is More Important Than You Think
If a workers’ comp adjuster called you soon after you filed your California workers’ compensation claim, that call is more important than you might think. Many injured workers think that the adjuster is there to help them with the claims process, but knowing what to say to a workers’ comp insurance adjuster—and, even more importantly, what not to say—can mean the difference between getting full medical care and benefits or having to wait, get denied, or get less money. For guidance, it is always best to consult with a workers’ compensation attorney in Glendale, CA.
Adjusters for workers’ compensation insurance usually get in touch with injured workers soon after a claim is made. They get information, ask how the injury happened, and ask for more information about your symptoms and recovery. Even though these talks may seem casual or friendly, everything you say is recorded and can affect whether your medical care is approved, how long you get temporary disability benefits, and the overall value of your case.
This article talks about who workers’ comp adjusters really work for, common tricks they use to get you to give up your rights, and useful tips for protecting your rights during those important first conversations. Knowing your rights under California law can help you avoid making mistakes that could hurt your claim, whether you’re getting questions about your injury, requests for recorded statements, or pressure to go back to work.
Who the Workers’ Comp Insurance Adjuster Really Works For
A workers’ compensation claims adjuster is not someone who works for you. They are an employee or agent of the insurance company that covers your employer’s workers’ comp. Adjusters in California look over your DWC-1 claim form and medical records, look into how you got hurt, and then decide whether to accept, delay, or deny your claim. [1]
The adjuster’s job is to look out for the insurance company and the employer who is insured. Their main jobs are to look into your claim by interviewing you, getting witness statements, and sometimes even watching you; to approve, delay, or deny medical treatment and disability payments; and to set aside money and negotiate settlements for the insurance company.
This makes it impossible to avoid a conflict of interest. The adjuster’s performance is often judged by how well they keep claim costs and duration under control, even though you need full, long-term medical care and fair wage replacement while you recover. A lot of the time, their goals are to keep costs down, question whether certain conditions are work-related or preexisting, and push cases toward quick, low-value settlements whenever they can. If you are dealing with an adjuster, a workers’ compensation lawyer can help protect your interests.
Knowing about this built-in tension can help you understand why adjusters use certain ways of talking to people and why it’s so important to be careful in early conversations.
Common Tactics of Workers’ Comp Adjusters
Using Casual, Friendly Conversations
Adjusters often talk in a friendly, casual way, as if they’re “just checking in” or “helping you get your benefits started.” This may make you feel better, but they are also asking you a lot of questions that will be written down in your claim file and used to determine how credible you are, how serious your injury is, and whether your story stays the same over time.
Requesting Recorded Statements
One of the most common things that people do is ask injured workers to give recorded statements early in the claims process. You can listen to these recordings later and write down what you hear to find any inconsistencies, supposed mistakes, or missing symptoms. You can question the validity of your claim if there are even small differences between what you said right after the injury and weeks later.
Asking Leading or Minimizing Questions
Adjusters are taught how to ask questions in a way that makes you downplay your injury. They might ask if the injury wasn’t “that bad,” if your pain is “better now,” or if you had similar symptoms before the accident at work. Even if your condition is serious and ongoing, these leading questions can make you agree with descriptions that hurt your case.
You might also be asked to guess how the injury happened or which body parts hurt, and then later, your own words might be used to say that you’re not sure about what caused it or that you didn’t mention certain symptoms at first.
Pressuring You to Return to Work Quickly
Adjusters may sometimes stress light-duty work offers or say you’ve been “cleared” to go back to work based on selective readings of medical notes, even if you still have major limitations. This pressure has two effects: it lowers the costs of temporary disability and creates paperwork that makes it look like you got better quickly.
Seeking Broad Medical Authorizations
Some adjusters ask for very broad medical releases that let them see years of unrelated medical history. Then, this information is used to say that your current problems are preexisting conditions, not work-related injuries like orthopedic or psychiatric injuries, which could lower or even take away your benefits.
What to Say and Not to Say to an Insurance Adjuster
Information You Can Safely Share
When an adjuster calls you, you can confirm some basic, non-controversial facts:
- Your full name, phone number, and email address
- Your job title, the claim number, and the date of the injury
- Proof that the injury happened at work or while you were working
- That you are getting or looking for medical care
You can reasonably say that you told your employer about the injury and filled out a claim form. You can also give the names of the doctors or facilities that treated you, but you don’t have to go into detail about what they told you about your diagnosis or prognosis.
Topics to Avoid Discussing
Don’t Guess About Fault: California workers’ compensation is a no-fault system, but adjusters may still ask how the injury happened or if you “should have been more careful.” Don’t guess who is at fault or offer information that could be used to lessen the employer’s liability or imply that you were careless. [2]
Don’t Downplay Your Symptoms: Saying things like “I’m fine now,” “it’s just a little sore,” or “I’ll probably be back to normal soon” can be used against you later to say that you were only hurt for a short time or mildly, even if your symptoms get worse or last for a long time.
Don’t Guess How Long It Will Take to Get Better: Don’t say when you think you’ll be able to go back to work or how long you think you’ll need treatment. You can use these predictions later to say that you’ve already healed or that you don’t need extra temporary disability benefits.
Be Very Careful With Recorded Statements: A lot of workers’ compensation lawyers say you shouldn’t give recorded statements without first talking to a lawyer. Recordings lock in specific details and make a permanent record that adjusters can use to weaken your claim by pointing out perceived inconsistencies, even if those differences are just the normal way that people learn more about their injuries over time.
Your Rights When Dealing with a Workers’ Comp Adjuster
Your Right to Medical Care
California Labor Code Section 4600 states that workers who are hurt on the job have the right to all medical care that is “reasonably required” to heal or ease the effects of the injury. [3] This includes doctor visits, diagnostic tests, surgery, physical therapy, medications, and any other care that helps with your work-related condition.
The claims administrator must approve up to $10,000 in reasonable medical care within one business day of receiving your claim form, even if the claim is still being looked into. This means you can get care right away without having to wait for the whole claims process to finish.
Your Right to Legal Representation
You have the right to talk to and hire a workers’ compensation lawyer at any time during your claim. An attorney can talk to adjusters for you, make sure that all the necessary forms are filled out correctly, and represent you at Workers’ Compensation Appeals Board (WCAB) hearings if there are any problems.
Your Right to Control Your Information
Insurance companies can ask for information as part of their investigation, but you can usually say no to having your conversations recorded and ask to talk to a lawyer before giving detailed statements. You also have the right to read all the papers carefully before signing them. You should be especially careful with global medical authorizations, releases, or settlement papers, as these could end your case for good.
When to Contact a Workers’ Compensation Lawyer
You should talk to a workers’ compensation lawyer right away if:
Early Warning Signs
- You have to give a recorded statement soon after your injury.
- Your medical care is delayed, denied, or limited without a clear medical reason.
- The adjuster asks if some body parts are related to your work injury or says your problems are already there.
- You are pushed to go back to work before you feel ready, or you are told that benefits may stop if you don’t comply.
The Importance of Early Legal Counsel
An experienced lawyer can make sure that the story of your injury is accurate and complete from the start by controlling how the facts are presented. Counsel can also fight against wrong denials or delays in treatment and temporary disability benefits, set up Qualified Medical Evaluator (QME) exams when there are disagreements, and keep you safe from adjuster tactics that are meant to lower the value of your claim. [4]
Many California workers’ compensation lawyers, including those who work for the WCAB, charge a fee that is set by law. This means that their fee comes out of your permanent disability benefits instead of needing to be paid up front. This makes it possible for you to get legal help even if you can’t work.
How ODG Law Group Protects Injured Workers from the Start
At ODG Law Group, we know that the first few minutes after a work injury are very important for protecting your rights and getting the benefits you deserve. Our method includes:
Early Advocacy in the Claims Process
We help hurt workers fill out the DWC-1 claim form correctly, report their injuries correctly, and write down the cause of the injury, the body parts that were hurt, and the symptoms in a clear and convincing way that builds a strong case.
Managing All Adjuster Communications
When you hire us, we handle all communication with insurance adjusters. We respond to their requests for information and let you know when—if ever—it’s okay to give statements and under what protective conditions.
Securing Your Medical and Wage Benefits
We strongly defend your right to medical care under Labor Code Section 4600, fight against unfair denials or delays of utilization review (UR), and seek temporary and permanent disability benefits at the WCAB when insurance companies don’t give you what you deserve.
Guiding Clients Through Every Step
We fully represent you at every stage of your workers’ compensation case, from getting you ready for QME or Agreed Medical Evaluator (AME) exams to negotiating fair settlements and finding overlapping employment law issues like retaliation or discrimination.
Protect Yourself Before the Adjuster Protects Their Bottom Line
The workers’ compensation insurance adjuster who calls you after your injury may sound helpful and concerned, but don’t forget that they work for the insurance company, not for you. Their main goal is to keep claim costs as low as possible, which is often the opposite of what you need: full medical care and full wage replacement while you recover.
You can protect yourself during these important early conversations by knowing what to say and what not to say, as well as your rights under California law. Most importantly, know that you don’t have to go through this alone.
If you’ve been hurt at work and a workers’ compensation adjuster has called you, the lawyers at ODG Law Group can help you protect your rights and get the most money possible from your benefits. Don’t let one conversation ruin your claim. Call ODG Law Group today for a free consultation. We’ll deal with the insurance company while you focus on getting better.
References
[1] California Department of Industrial Relations. “Workers’ Compensation in California: A Guidebook for Injured Workers.” [2] California Department of Industrial Relations. “Workers’ Compensation System.” [3] California Legislative Information. “Labor Code Section 4600.” [4] California Department of Industrial Relations. “Qualified Medical Evaluator (QME) Process.”
