What Not to Say to the Workers’ Comp Adjuster

What Should You Not Say to a Workers’ Comp Adjuster?

Injured workers should be careful when communicating with a workers’ compensation claims adjuster because statements made early in the claim may later be used to dispute medical treatment, temporary total disability benefits, permanent partial disability, or settlement value. A Chicago workers’ compensation attorney can help injured workers understand what information should be shared and how to avoid statements that may hurt the claim.

Workers' Compensation Claims

In most states, including Illinois, employers are required to provide workers' compensation insurance for employees. This insurance may cover work-related accidents and injuries, medical bills, lost wages, rehabilitation expenses, temporary total disability, and permanent disability benefits. If your injury involves physical labor, jobsite hazards, repetitive strain, or lifting, related resources on workplace injuries, construction accidents, and lifting injuries may also be helpful.

Illinois workers' compensation claims and benefits are handled by the Illinois Workers' Compensation Commission (IWCC). When work-related injuries occur, the injured worker must file a claim directly with his or her employer within a specified time frame, then the employer must file a timely claim with IWCC. Once IWCC approves the claim, the injured worker receives benefits usually through weekly or bi-weekly payments.

Although Illinois workers’ compensation claims do not require proof of fault for work-related accidents and injuries, all claims must be reviewed and investigated by state workers' comp adjusters to determine how the accident occurred, the severity of the worker's injuries, and the dollar amount to be paid in benefits.

When a work-related injury occurs, it's essential for victims to see a physician as soon as possible. Depending on insurance requirements, a worker may be referred to a specific doctor within the insurance network or a specialist who treats certain conditions. In some cases, an injured worker can ask for a panel of physicians to review his or her case. A panel of physicians is more likely to give a better outcome for a claim than a single doctor chosen by the insurance company.

In most cases, workers' comp claims are approved, but IWCC may deny claims based on the claims administrator's or claims adjuster's findings. Common reasons for claim denials include:

• A worker fails to report the accident and injury to his or her employer within the specified time limit (within 30 days after the accident)
• The employer fails to report the claim to IWCC within the specified time limit (up to 60 days after the accident)

• The employer claims the injury occurred outside of the workplace
• The employer claims the injury occurred outside of normal work duties

• The examining physician claims the worker did not suffer injuries serious enough to warrant medical treatments
• There is not sufficient medical evidence to support the injury claim

If a workers' compensation claim is denied, the injured worker may have the right to challenge the denial through the Illinois Workers’ Compensation Commission. In many cases, a workers' comp lawyer investigates the claim, gathers medical evidence, prepares for a hearing, negotiates a settlement, or files an appeal. If you are dealing with unpaid treatment after a denial, the article on what happens to medical bills when workers’ comp is denied may also be useful.

What is a Workers' Comp Adjuster?

A workers’ compensation claims adjuster evaluates insurance claims. The job of an adjuster is to gather information and facts about an accident and injury to determine whether an insurance company must pay the claim under the Illinois Workers’ Compensation Act. The information and facts gathered by the adjuster will play a significant role in determining what type of workers’ comp benefits should be paid and how much money will be offered to settle the claim.

How Workers’ Comp Adjusters Affect Illinois Claims

Illinois workers’ compensation claims are handled through the Illinois Workers’ Compensation Commission, but insurance adjusters often play a major role before the case reaches a hearing or settlement. The adjuster may review statements, medical records, work restrictions, wage information, and reports from doctors or an independent medical examination.

Statements to the adjuster may affect issues such as:

• Causation: Whether the injury happened at work or was caused by something outside the job.
• Medical benefits: Whether treatment, therapy, imaging, injections, surgery, or medication should be paid.
• Temporary total disability: Whether wage benefits should be paid while the worker is off work.
• Work restrictions: Whether the worker can return to light duty, modified duty, or regular work.
• Average weekly wage: Whether wage benefits are being calculated correctly.
• Permanent partial disability: Whether the injury caused lasting impairment that may affect settlement value.
• Maximum medical improvement: Whether the insurer claims treatment has ended or the worker has recovered enough to resolve the claim.

Because these issues can affect benefits and settlement value, injured workers should keep communications factual, accurate, and limited to the claim.

Talking to a Claims Adjuster

Although injured workers may be contacted by a workers’ comp adjuster, they should be careful before answering detailed questions or giving a recorded statement. The adjuster may ask about how the injury happened, whether symptoms began immediately, whether there were witnesses, whether the worker had prior injuries, and whether the worker can return to work. Answers to these questions may later be used to dispute the claim, delay medical benefits, or reduce settlement value.

Before speaking with an adjuster or agreeing to a recorded statement, injured workers should consider speaking with a workers’ compensation lawyer. A lawyer can help prepare for the conversation, explain what information should be shared, and prevent the adjuster from asking misleading or overly broad questions.

Common Questions a Workers’ Comp Adjuster May Ask

Many adjuster questions sound routine, but the answers can affect the claim. Injured workers should answer truthfully, avoid guessing, and avoid adding unnecessary details that go beyond the question asked.

• When did the injury happen?
• Where were you working when the accident occurred?
• What job task were you performing?
• Who witnessed the accident?
• When did you report the injury to your employer?
• What body parts were injured?
• When did symptoms begin?
• Did you have any prior injuries or pre-existing conditions?
• What medical treatment have you received?
• Did your doctor give you work restrictions?
• Are you currently working, off work, or on light duty?

If you do not know the answer to a question, it is better to say you do not know than to guess. If you need to review records, medical notes, or dates before answering, say so.

What to Say to a Workers' Comp Adjuster

Stick to Basic Facts

Rather than giving too many details about the accident and injury, it's best for victims to stick to basic facts. Elaborating about details and facts can result in information that can be used to jeopardize the claim.

Even if mistakes are made accidentally, the insurance company sees that as fraudulent information. When recounting how an injury occurred, victims should reveal: (1) The time and date of the injury, (2) Where the injury occurred in the workplace, (3) what type of accident led to the injury, and (4) which parts of the body sustained injuries.

Describe the Injuries

When describing injuries, it's important to be as inclusive as possible about details. If an injury isn't fully described or it's left out of a statement, there’s a good chance the insurance company will not pay for medical treatment for that injury. For example, neck injuries often cause arm pain, shoulder pain, and headaches. When describing a neck injury, it's important to also describe any pain in other areas that may be related.

Answer Questions About Pre-Existing Conditions

In some cases, injured workers try to hide pre-existing conditions from a workers’ comp adjuster because they think it may reduce the value of their claim. While pre-existing conditions are not covered by workers’ compensation, new injuries that aggravate a pre-existing condition are usually covered. Workers' comp adjusters will find out about pre-existing conditions through medical records, so it's best for claimants to answer questions truthfully. Trying to hide a pre-existing condition will only give insurance companies an easy excuse to deny a claim.

What Not to Say to a Workers' Comp Adjuster

Do Not Agree to be Recorded

A recorded statement requested by an insurance company should be approached carefully. Giving a recorded statement can make it easier for the insurer to identify inconsistencies, incomplete injury descriptions, or accidental wording that may be used to dispute the claim. If the adjuster is asking for a recorded statement after a serious injury, a workers’ compensation attorney can help you decide how to respond.

Do Not Sign Any Documents

Workers' compensation claims that involve serious or life-threatening injuries such as burns, electrocutions, disfigurement, and amputations, or physical and mental disabilities often get resolved through settlement agreements between lawyers and insurance companies. Before signing any documents with a workers' comp adjuster, it's important for a workers' comp lawyer to review the documents or settlement offers made by the insurance company. Even if the settlement seems generous, it may not be fair or adequate to cover medical bills, lost income, or long-term physical disabilities.

Do Not Answer Questions about Family and Finances

Workers' comp adjusters often ask questions about an injured worker's family and finances, but these questions have no bearing on a workers' compensation claim. These types of questions are asked to find out personal information that may signal income and financial difficulties. The adjuster and insurance company may use this information to create a low settlement offer thinking that it may be quickly accepted.

Do Not Get Too Conversational

Claimants should keep in mind that insurance companies want to settle injury claims as quickly as possible at the lowest possible price to protect company financial assets.

Workers' comp adjusters are motivated to find loopholes in workers' compensation claims and pay as little as possible in settlement awards to injury victims. When talking to an adjuster, keep casual conversations to a minimum. Stick to the facts and don't get sidetracked with chatty conversations that can relay detrimental information to the insurance adjuster.

Settlement Agreements

When negotiating a fair settlement with an employer's insurance company, workers' comp lawyers have the advantage of being able to estimate how much the case is worth. Negotiating a fair workers' comp settlement for the injury victim depends on a variety of important factors including:

• The extent and severity of the worker's injuries
• Job limitations caused by injuries
• Temporary or permanent disabilities caused by injuries
• Lost wages and late payment penalties owed by the employer
• Past and future medical expenses caused by injuries
• Previous wages of the injured worker

Workers' comp lawyers are skilled in various negotiating tactics and know about all the tricks used by insurance companies, like “low-ball offers” that provide unfair settlement awards and “final offers” that are not really final. Working with a lawyer can ensure that a fair settlement is properly written to prevent negative actions with current and future Social Security disability benefits.

Court Hearings and Trials

If workers' compensation benefits are denied, and a fair settlement can't be reached, the next step is an administrative hearing or a court trial before a workers' comp judge and/or a trial jury. Both of these processes can take weeks, months, even years to resolve, depending on the court docket and the complexity of the accident and injuries.

An administrative hearing and court trial must go through various stages of discovery and pleadings before a final decision can be reached. The “discovery process” includes a thorough investigation of the workers' comp case, documented proof of injuries through medical records, and witness depositions. The “pleading process” includes written petitions, motions, and written responses to the employer's insurance company.

A workers' comp lawyer will oversee these processes, evaluate written responses, and make sure all paperwork is submitted on time to the court judge. At the administrative hearing or the court trial, a workers' comp lawyer will instigate opening and closing arguments, question all available witnesses, and present documented evidence that substantiates workers' compensation benefits for the injured worker.

While the workers' comp judge will have the final decision regarding benefits and settlement awards, a workers' comp lawyer is necessary to prove the case and win benefits for the injured worker.

What Should You Do Before Talking to a Workers’ Comp Adjuster?

Preparation can help injured workers avoid accidental statements that create problems later. The goal is not to hide information, but to make sure the information provided is accurate, complete, and limited to the workers’ compensation claim.

• Write down the basic facts: Date, time, location, job task, accident description, and witnesses.
• List every injured body part: Include pain, numbness, weakness, radiating symptoms, headaches, or worsening symptoms.
• Review medical treatment: Know where you were treated, what doctors said, and what follow-up care was recommended.
• Keep work restrictions handy: Save disability slips, light-duty restrictions, and return-to-work notes.
• Do not guess: If you are unsure about a date, diagnosis, or detail, say you need to confirm it.
• Decline unnecessary recorded statements: Ask whether the statement is required and speak with a lawyer first.
• Do not sign documents immediately: Have a lawyer review releases, settlement documents, or broad medical authorizations.

If a workers’ comp adjuster is asking for a recorded statement, pressuring you to sign documents, delaying medical approval, or disputing your injury, contact Strom Yen Injury Attorneys to discuss your claim and next steps under Illinois workers’ compensation law.

Workers’ Comp Adjuster FAQs