Workers’ Compensation Adjusters’ Dirty Little Secrets

Injured at work in North Carolina? Confused about the process, the law, and whether you are being treated fairly? Many times, it is no accident that the insurance adjuster seems to know it all and leaves you in the dark – with knowledge comes power. Below are the top three secrets the insurance companies do not want you to know:

  1. Insurance adjusters are often wrong.

Insurance adjusters handling North Carolina workers’ compensation claims often live and work far away, even across the country. They sometimes handle claims in several different states, and with each state comes totally different law. Plus, they are overworked, sometimes juggling hundreds of cases at a time. Many adjusters even handle other types of claims aside from workers’ compensation. Let’s face it…they are human and can make mistakes.

The workers’ compensation attorneys at Ricci Law Firm often see workers’ compensation adjusters who have denied a claim or paid insufficient benefits based on incorrect law. Sometimes the adjuster accidentally applies the wrong state’s laws. Sometimes the adjuster is not aware of recent changes to North Carolina law. And sometimes the adjuster just fails to review the full file. Often, the error is unintentional. Regardless, if you question a decision from an insurance adjuster, reach out to a workers’ compensation attorney.

  1. The insurance company’s “policy” is not always the law.

Many North Carolina workers hear the following from adjusters:

  • “Our policy prohibits us from paying more than $___ to close out your claim.”
  • “Your claim is not compensable, because under our policy it was filed late.”
  • “Your claim is “meds only” because we do not pay disability benefits without documentation.”
  • “Our policy is to use the past year’s wages to determine the amount of benefits.”
  • “By policy, we deny all claims unless medical treatment is received within 30 days of accident.”

Beware of any mention of company “policy;” often, it is nothing more than an internal policy designed to boost the insurance company’s profits. In the end, those “policies” might not hold up under the North Carolina Workers’ Compensation Act.

  1. A recorded statement may contain only the wrong questions.

For many sick or injured workers, one of the first encounters with the workers’ compensation adjuster involves giving a recorded statement. Hard-working, honest employees, knowing they have nothing to hide, may agree to give the recorded statement. After all, if the worker simply tells the truth, there is nothing to fear, right? Unfortunately, the interviewer likely is very familiar with the booby traps of workers’ compensation claims and is trained to ask only questions to weaken the claim, not strengthen it. The interviewer usually sounds friendly – even casual – when asking questions.

Be careful! The standard interview questions may be carefully scripted by savvy insurance company executives to trip up even honest workers. In some cases, using just one wrong word to describe the incident can make the difference between accepted or denied. Before giving a recorded statement in a workers’ compensation case, sick and injured workers in North Carolina should consult a workers’ compensation attorney.

Secrets only work if they stay secret, and the specialist workers’ compensation attorneys at Ricci Law firm want you to know the truth. Do not fall victim to the common traps. If you have a question about your claim, contact us.

Workers’ Compensation Lawyer NOW serving Greenville, Durham, Goldsboro, and Raleigh

I’m Brian Ricci, a workers’ compensation lawyer serving Greenville and Raleigh. If you or a loved one has sustained an injury at work, please call me at (252) 777-2222 or 800-387-6406 for free, friendly advice.

I am a longtime member of the Million Dollar Advocates Forum.

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