If you’ve sustained a workplace injury, it’s easy to jump to the conclusion you will have to “fight” for compensation – and the claims adjuster may personify your enemy.
While claims adjusters do indeed loom large in any workers’ compensation case, let the skilled Las Vegas workers’ compensation lawyers at Greenman, Goldberg, Raby and Martinez explain what claims adjusters do and how a fair-minded attitude can lead to a smoother claims process.
What claims adjusters do
Essentially, claims adjusters evaluate, investigate and settle claims, or requests for compensation for workplace injuries. Once a claim arrives on their desks, according to the U.S. Bureau of Labor and Statistics, they:
- Determine whether the insurance policy covers the claim
- Interview the claimant and witnesses and research the claim
- Contact claimants’ doctors or employers to get additional information
- Ensure a claim is not fraudulent
- Confer with legal counsel on a claim when needed
- Decide the appropriate amount the insurance company should pay
- Negotiate a settlement
- Authorize payment
- Work with Las Vegas workers compensation lawyers and expert witnesses to defend the insurer’s position if the claimant contests the outcome of the settlement
Think of claims adjusters as arbiters
Since claims adjusters are employees of the insurance company, it’s easy to think of them as the advocate of the insurance company, not the claimant.
Claims adjusters must follow the guidelines for the company they work for — and their specific duties and scope of authority can vary from one company to another. The Las Vegas workers’ compensation lawyers at Greenman, Goldberg, Raby and Martinez prefer a more fair-minded if not benevolent term: they regard claims adjusters as arbiters in the claims process.
Setting the right tone – and mindset
This important difference can set a more harmonious tone in a workers’ compensation case – starting with the day a claims adjuster is notified someone has filed a claim for compensation with his or her insurance company.
As this juncture, the claims adjuster adopts the role of investigator, scrutinizing both the employees’ initial report as well as the medical report from the attending physician. The employee often is asked to see a physician designated by the insurance company, to ensure there is no disparity between the two diagnoses and treatment plans.
If a discrepancy exists, the claims adjuster must intensify his or her investigation – interviewing anyone who was party to the workplace injury to ensure a fair outcome for both the injured employee and the insurance company.
No workers’ compensation case should be considered “open and shut.” There is no such thing. This said, some cases are more complicated than others. For example, those involving the use of hazardous chemicals in the workplace can be particularly vexing, especially if the nature and scope of the sustained injuries are just coming to light.
No matter the nature of a workers’ compensation case, cooperation with all the players is vital. It not only ensures a smoother claims process; it often mitigates delays. Moreover, it is imperative the information supplied to a claims adjuster is accurate, comprehensive and detailed.
Contact the Las Vegas workers’ compensation lawyers
If you’re working with the most thorough Las Vegas workers’ compensation lawyers at Greenman, Goldberg, Raby and Martinez, they will see to it – and get your claim settled as expeditiously as possible. Call 702-388-4476 for a free consultation and let the skilled Las Vegas workers’ compensation lawyers of GGRM take care of you and your case.