How to Talk to Insurance Claims Adjusters

How to Talk to Insurance Claims AdjustersIf you have been injured overseas on a contracting job, and you are pursuing a claim through the Defense Base Act, there are some things you should know about dealing with your employer’s insurance company.

Not meaning to bash anyone here, insurance companies or their adjusters, but you must be very careful in your interactions with them.  If you make a mis-step, you might be losing some of the benefits that should be given to you under the DBA

1. Tell the Truth

The first thing you must do is absolutely tell the truth about your injury.  If the accident made an old injury or condition worse, it is still usually fully compensable, so there is no need to lie about or exaggerate your injury.  This concept has been longstanding, since a 1968 case that said that the work related injury must merely “aggravate, exacerbate, accelerate, contribute to or combine with” a pre-existing condition.  In this day and age of electronic medical records, if you had a prior injury or condition and did not disclose that fact, it most likely will be found out.

If your claim is disputed and has to be decided by an administrative law judge, lying about the injury will certainly hurt your chances.  It is very important to be completely truthful in your claims and statements so that there is not even a chance the judge thinks you may be trying to defraud the insurance company.

2. Don’t Take Advice From The Insurance Claims Adjuster

The claims adjuster is often cast in the role of the bad guy in these cases.  Of course, their role is to investigate your claim and initially decide whether the claim is valid and whether (and how much) the insurance company should pay.   You must of course co-operate with them in their investigation – no need to be rude!- but you should also be careful not to disclose too much information too soon, especially very early on in the claim.  In a sense it really is You vs. Them, and we want You to prevail.

It’s also probably a bad idea to take legal advice from an insurance adjuster – remember they are not your friend, and are trying to do their job, which is to save the insurance company money.  Also, it’s not a good idea to hire an attorney that the adjuster suggests – they may be a bit too chummy with the insurance company and not the best advocate for you.  If the adjuster says something like, “Try Attorney XYZ, we know we can work with them,”  you should be running in the opposite direction!

3. Don’t Sign Anything!

This is where many claimants make a costly mistake.  The insurance company says (or implies) that you need to sign “authorizations” in order to get

Signing a document your payment.  This is absolutely not true.  While the insurance company is certainly entitled to your medical information and your employment information, you do not need to sign authorizations to provide that to them.  Unfortunately,  sometimes buried deep within the legalese of these documents is release settlement language.  If you sign your rights away, it may be difficult (if not impossible) to get them back.  This is where you really need an experienced DBA attorney.

4. Don’t Give Any Written or Recorded Statements!

Other than the claim forms, which should have the information on how the accident happened and the nature of your injuries, you should not give the insurance company any further statements.  These will only be used against you as you proceed with your claim, and can come back to bite you.  Should the claim be contested, and if it is litigated, your own words may be your worst enemy.

5. Don’t Let the Nurse Case Manager Direct Your Treatment!

Sometimes the Nurse Case Manager (who works for the insurance company!) wants to attend your doctor visits or physical therapy sessions.  This is not a good idea.  While their job is to assess and monitor your case, they are also on a mission to save the insurance company money.  The insurance company is entitled to your information, but if they try to attend your doctor visits, or direct your care in any way, they need to be politely removed from the equation.

Perhaps this should go without saying, but we are saying it anyway – do not let them choose your doctor, and do not go to a doctor your insurance company has recommended!!  Often these doctors depend on getting work from the insurance companies, and you may be doing a disservice to yourself.  You get your choice of doctor with these claims, and you want to make sure it is someone who can provide the best treatment for your injury.  You want someone looking out for your best interests, not the insurance company’s bottom line.  Handling this may be a job for the seasoned DBA attorney, who can defuse these situations.

6. Get a Professional Involved

Insurance companies are a business, and just like any business, will go to great lengths to save and make money.  Every claim they don’t have to pay is money in their pocket.  The tactics we have discussed here, and others we have seen, sometimes surprise the claimants, who just want to be fairly paid for the injury they sustained, and for which they thought they were insured.  Often they don’t realize that the insurance company can be a bit of a bully when they think they have to give up some of their money.

If you have been injured overseas on a contracting job, you should get yourself some professional legal help.  An attorney dedicated to and experienced in Defense Base Act claims can help keep the insurance company on the straight and narrow, and help insure you get all the benefits to which you are entitled.