How Claims Adjusters Investigate Workers’ Comp Claims

Posted on

Baltimore Workers’ Compensation Lawyers discuss claim investigations by claims adjusters and how they can result in a denied claim. Workplace injuries can happen when you least expect it, whether you work in the construction industry or in an office setting. Serious injuries can result in costly medical bills, lost wages, and permanent disability if the injury prevents you from returning to work at all. When this happens, workers depend on, and are entitled to Workers’ Compensation benefits. However, it is often up to the claims adjuster to determine whether the claim will be approved and the amount of financial benefits the employee will receive. Unfortunately, there is a growing concern that too many claims adjusters deny claims without performing a comprehensive investigation.

After a Workers’ Compensation claim has been submitted to the insurance carrier, they must investigate the injury and decide whether the claim is compensable. At the very least, you would assume that the adjuster would speak with the injured worker, collect an accident report from the employer and statements from witnesses, as well as obtain medical records from the worker’s healthcare provider. Unfortunately, this does not always happen. In fact, in some cases, claims adjusters have been known to ignore pertinent information and proceed with denying the claim.

Impact of Claims Adjusters’ Decisions

Consider the following scenario. A worker suffers a serious injury while on the job and is rushed to the emergency room in an ambulance. The details of the injury are reported to the employer in a timely fashion, and complete medical records are provided as soon as they were available. Because of the injury, it is unknown if or when the employee will be able to return to work. Their only income is their weekly Workers’ Compensation benefits. However, after receiving a Workers’ Compensation denial notice in the mail, which stated that no work injury occurred on that date, the injured worker stops receiving benefits.

In situations like this, it is imperative that an investigation be performed, and penalties imposed if it becomes clear that a reasonable investigation was not performed by the claims adjuster. A penalty petition must be filed stating that the adjuster failed to conduct a thorough investigation into the claim. The petition should also include a subpoena for the adjuster’s file and log notes. Penalties were established to deter future bad faith behavior. Injured workers who pursue legal action against an insurance carrier often must go without income or medical coverage for the duration of the litigation process. This can be devastating for the worker and their family, both financially and medically.

Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Protect the Rights of Injured Workers

If you have been injured at work and a claims adjuster denies your claim, contact the Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton as soon as possible. If your claim was denied based on an incomplete investigation into your injury, we will file a petition against the claims adjuster and help you appeal the denial. More importantly, we will fight so that you receive the full benefits to which you are entitled. To schedule a free consultation, call us at 844-556-4LAW (4529) or contact us online.