22 Things Your Workers Compensation Adjuster Should Not Do

Self-insured employers often get into trouble for not being knowledgeable of the requirements of the Unfair Claims Practice Act in the state(s) where it is being self-administered for workers compensation claims. The failure to act in a totally ethical manner can lead to litigation by the party wronged and to fines and/or the suspension of the self-insured's authorization to be self-insured by the State.

1. Knowingly misrepresenting the benefits available under the state's workers compensation law
2. Failing to contact the injured employee (hoping the employee will not pursue the claim)
3. Failing to investigate the claim properly
4. Denying compensability without a valid reason
5. Failing to file all necessary state forms
6. Recording the employee's statement when the employee is under the influence of medications or distracted by pain
7. Failing to provide a copy of a recorded statement or written statement when one is requested
8. Recording telephone calls without the other party's knowledge of the call being recorded
9. Knowingly documenting the file notes with inaccurate information
10. Intentionally not returning phone calls of the employee or medical provider in an effort to discourage the claim
11. Failing to pay indemnity benefits timely trying to coerce the employee in to returning to work prematurely
12. Failing to authorize needed diagnostic testing without reason to not authorize
13. Failing to pay for permanent partial disability
14. Paying less than the workers comp statute calls for when settling a permanent partial disability
15. Offering to settle and close out future benefits for an amount significantly less than what the adjuster knows to be fair
16. Advising the employee not to hire an attorney
17. Threatening to reduce the settlement of the claim if the employee hires an attorney
18. Discussing any aspect of the claim with an employee known to be represented by an attorney
19. Settling the claim before the extent of disability is known
20. Overstating the damages and exposures so that the adjuster's supervisor will extend excessive settlement authority, allowing the adjuster to make a quick (but overpaid) settlement
21. Providing the employee's personal information to parties who do not have a legitimate need to know
22. Having a financial interest in any vendor utilized on the claim

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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