Content reviewed by:
Alex Shulman
If you’ve filed a workers’ compensation claim after an injury, you’ll have to deal with your employer’s insurer. Initially, the workers’ comp insurer might seem like an unbiased third party assessing your case. However, it’s important to remember that insurance companies often prioritize their interests over yours. Their primary goal is to minimize payouts, even if it means denying you the full and fair compensation you deserve.
Before speaking with your employer’s insurer, you should consult an experienced workers’ comp attorney who can help you understand your legal rights and fight for the compensation you’re entitled to. Contact us online or call (212) 221-1000 today to schedule a free consultation.
Understanding Workers’ Compensation Insurance Companies
Workers’ compensation is governed by specific state laws that dictate how claims are handled, what benefits are available, and the rights of both employees and employers. While also highly regulated, the legal framework for other types of insurance is less specialized for the context of workplace injuries and employment relationships.
In New York, employers can get workers’ compensation insurance through private insurance companies or the State Insurance Fund (NYSIF), a not-for-profit government agency. They can also be self-insured.
Ultimately, insurance companies are not on the side of workers, even if their adjusters seem trustworthy or act like they’re doing you a favor. To protect their bottom lines, they will sometimes try to spend as little money as possible instead of compensating workers fairly. Hiring our experienced New York workers’ comp attorneys to handle your case is the best way to protect your rights.
What Workers’ Compensation Investigators From Insurance Companies Look For
Insurance adjusters analyze workers’ compensation claims, categorizing them into two categories: compensable and non-compensable. If a claim is deemed non-compensable, workers’ comp benefits are denied. If the claim is compensable, the adjuster will determine the benefits that are payable. The adjuster’s responsibilities include:
- Reviewing your employer’s insurance coverage
- Determining your average weekly wage
- Ensuring you reported your accident to your employer within 30 days
- Ensuring you filed your Employee Claim (Form C-3) with the Workers’ Compensation Board within two years
- Gathering medical reports and witness statements
- Determining whether your medical provider is authorized to treat your injury or illness
Tactics Used by Workers’ Compensation Investigators
Workers’ comp adjusters may employ various tactics to undermine your claim. They might take your statements out of context, making your injury seem less severe. They may ask leading questions to get you to downplay your injury. In some cases, they may even use illegally deceptive tactics, such as claiming that your claim could be affected by your citizenship status (it will not).
Communication with Workers’ Compensation Insurance Companies After a Workplace Injury
It is recommended that you consult with an attorney after being injured at work. Once you have retained counsel to represent you, the insurance company cannot speak to you directly and must communicate with your attorneys.
Your attorneys can ensure that you meet any deadlines set by the orkers’ Compensation Board or required by the claims process, such as submitting forms or attending medical appointments. Again, in New York, you must report your accident to your employer within 30 days after your injury.
The insurance company will absolutely hire defense counsel to represent their interest in all legal proceedings. It is advisable that you retain a law firm to represent your interests and pursue the full extent of benefits that you are entitled to under the law.
What Workers’ Compensation Investigators Can and Can’t Do
Insurance is a highly regulated industry, in large part to protect consumers against unfair practices. Adjusters cannot coerce, retaliate against you, or deny a legitimate claim without basis. Insurance adjusters are also prohibited from committing fraud, which may include falsifying claim information, misrepresenting facts, or manipulating evidence to deny or reduce payouts. There are many ways to report insurer fraud to state authorities.
If your employer’s insurance provider disputes your claim, they may hire private investigators to assess how your injury impacts your daily life. Within legal boundaries, investigators can review your social media, interview those close to you, contact you directly, and even observe you in public places. However, workers’ comp investigators cannot engage in illegal activities, such as trespassing on private property, placing tracking devices on your vehicle, hacking into your online accounts, or impersonating law enforcement.
Common Pitfalls to Avoid
There are a number of things you can do to protect your workers’ compensation claim. There are also a number of things you should not do. Avoid these pitfalls after a workplace accident:
- Failing to report your injury to your employer in a timely manner
- Using your own health insurance to cover workplace injuries
- Not seeking prompt medical attention
- Failing to document the incident
- Not following your doctor’s advice
- Providing inconsistent statements
- Posting on social media during your claim
- Not understanding your rights
- Settling your claim too quickly
- Not consulting an attorney
Handling a workers’ compensation claim on your own can be complicated and frustrating, especially if your injuries are severe or you have a permanent impairment. Our attorneys can help, including by protecting your rights against adjusters eager to minimize your claim.
Protecting Your Rights as an Injured Worker
Dealing with workers’ comp insurers can add stress to an already difficult situation, as they may prioritize their financial interests over fairly compensating injured workers. That’s why it’s crucial to seek legal counsel before dealing with insurance adjusters on your own. A dedicated workers’ comp attorney can make all the difference in securing the benefits you’re legally entitled to.
If you’ve been injured in a workplace accident and need someone to negotiate with insurance adjusters on your behalf, Shulman & Hill can help. No case is too significant, complex, or challenging for our experienced attorneys. Contact us online or call (212) 221-1000 today to schedule a free consultation. Ofrecemos servicios en español.
