Dirty Tricks Of The Illinois Workers Compensation Adjuster

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Insurance adjusters are individuals that represent insurance companies in Illinois Workers’ Compensation claims. Their goal is typically not to help the injured workers, but to use different tactics in order to best benefit their employer. The insurance companies are not looking out for you but are looking to limit your benefits to avoid payouts on their end. Adjusters’ roles are to reduce and/or inhibit persons like yourself, who have suffered injuries at work, from receiving the benefits you should be entitled to. In fact, many adjusters are compensated based off the money they save by depriving you of legally owed benefits such as payments of medical bills, TTD compensation or a settlement.

It is often difficult for injured workers to aware of the benefits they are being conned out of as adjusters use different tactics to subtly trick the injured. Having an attorney can usually solve the problem. We wanted you to be aware of some of the tricks to look out for which are signs that calling an experienced Illinois work comp lawyer is a good idea.

The most common tactic used is the denying the injury without cause. Adjusters will deny a claim by stating that a legitimate work-related injury did not actually happen on or from the job. They tend to claim they’ve completed an investigation and they have found no relation between the injury and bounds of employment. A lot of the time the injured worker believes the adjuster, making this their favorite tactic due to the successfulness. However, most of the time, there is no good reason for denying a claim. Their hope is that you will simply go away. Sadly, it works enough that they keep doing it.

In close relation to denial of injury, adjusters will fake an investigation. Injured workers must receive approval for a variety of medical procedures and tests to evaluate their injury. Adjusters will commonly claim that an investigation is underway and they aren’t able to approve the tests yet. They’ll claim that they are still gathering records and witnesses but those claims are mostly untrue. They are trying to delay the claim as long as they can because it will benefit them in the end. If they delay you long enough, maybe you’ll use your own insurance or go back to work when your doctor says you shouldn’t. Both of those results save them money no matter how scummy a tactic it is.

Sometimes, when adjusters are ‘completing an investigation’ they will request your medical records. Adjusters will use the tactic of requesting any and all medical records from an injured worker. They are only entitled to the records that are connected to the injury that was sustained at work. They are not allowed to obtain records from previous injuries of body parts that are not connected to the injury. For example, if you hit your head at work, they cannot obtain records of your pregnancy or psychological care from 5 years ago. They want all of your records because it’s basically a fishing expedition to come up with a defense or something that can be used to embarrass you.

As mentioned previously, adjusters are entitled to access your medical records, only the relevant ones of course. Many adjusters tend to act as medical professionals as they provide medical advice to injured workers. They’ll claim you don’t need to be off work that long or don’t need that many physical therapy appointments. These claims are all extremely biased as their recommendations are only beneficial to them and their employers. It is important to always take the advice of a true medical professional. We’ve seen adjusters try to say to a worker that they only need physical therapy once a week when the doctor says they need it three times a week. Others will refuse to authorize a MRI because they don’t find it necessary. This is all against the law.

An adjuster may cooperate and not engage in any of the above tactics. You could receive your proper medical care and get paid for your time lost then call the adjuster for a settlement. The adjuster will falsely claim that your case is closed. Your case is not actually closed, they are just hoping you believe them and give up and go away. It is important to file your claim with the State before the statute of limitations which is either three years from the accident date or two years from the last payment of benefits in your case. If you do, your case can always be “reopened.” Remember, just because they say it’s closed doesn’t mean that it really is. In fact, this is a problem a lawyer can typically solve the day you hire them.

Arguably, the most irritating tactic used by adjusters is ignoring the injured worker. They will avoid any kind of communication with the injured worker by never returning calls or emails. Their goal of this tactic is to wear the injured down in hopes they will give up on their claim and never see a doctor. They can’t ignore trial motions though. So if benefits aren’t being paid, your lawyer can file a 19(b) petition for immediate hearing which will make the adjuster respond.

Other tactics they use to harm you include telling you that you have to give a recorded statement (you don’t have to and shouldn’t) and assigning a nurse case manager to your claim. While that is legal, the nurse will often be instructed to talk directly to your doctor, schedule and attend your doctor appointments and interfere with your care. All of those acts are illegal and designed to harm you.

Adjusters use these tactics to help their employer, the insurance company, avoid paying what they should which inevitably swindles injured workers out of their benefits. These tactics are annoying and frustrating, but they can be overcome by an experienced attorney. If you are in the state of Illinois and have any questions or would like to discuss a case, please call us for free any time at 312-346-5320.