20 Unfair Claim Practices For Your Adjuster To Avoid
The workers' compensation adjuster, who is often dealing with attorneys out to maximize the cost of the workers' comp claim, or with employee claimants who are attempting to commit fraud, may be tempted to fight fire with fire. The adjuster should always handle the claim in an ethical manner. If an adjuster is doing any of the following, stop everything and discuss the adjuster's actions with the adjuster.
Unfair claim practices by the adjuster include:
Failing to contact the injured employee (hoping the employee will not pursue the claim)
Discussing any aspect of the claim with an employee known to be represented by an attorney
Settling the claim before the extent of disability is known
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
Providing the employee's personal information to parties who do not have a legitimate need to know
Having a financial interest in any vendor utilized on the claim
Mistakes, Oversights, & Poor Claim Handling Are Not Unfair Claims Practices
Mistakes, oversights, and poor claim handling are not unfair claims practices. The workers compensation adjuster often has more work to do than it is possible to get done. With the telephone ringing constantly, the e-mail flooding in, having numerous deadlines for filing forms, numerous deadlines to prepare for mediations or conferences, and numerous other items that need to be completed, it is normal for some things to fall through the cracks. When the adjuster does not contact the injured employee timely, or does not respond to a settlement demand from the employee's attorney, it is normally because the adjuster has more to do than is possible to get done. It only becomes an unfair claims practice when the adjuster intentionally decides not to take needed action in an effort to impact the overall outcome of the claim.
Almost all adjusters are honest and have the best interest of both the employee and the employer at heart. If you do notice any of the above issues occurring, stop and discuss the issue with the adjuster. Often there is an ethical and valid reason for the adjuster's action which will become apparent when you learn more about the reason for the adjuster‘s actions. Only when the adjuster sets out to act dishonestly should you be greatly concerned.
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