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Issue with Workman Comp Adjuster

Sacramento, CA |

I have filed a complaint again my claims adjuster every time she has ignored my doctors request for treatment, cancelled my prescription part of my claim (non-narcotic) and many other unethical things. the attorney for the company has asked that I only deal with her. But shouldn't I have access to my claims adjuster? The attorney is not authorized to grant any of my doctors request or handle my medial mileage reimbursement. The claims adjuster is now concerned because I had to write her up for every offense...why don't they just give me an adjuster who is willing to do a good job and not ignore my doctors and my request for qme approved services. She has refused to send on request to the UR for review

Attorney Answers 6

  1. Best answer

    You deal with the lawyer and let the lawyer deal with his adjuster. You will get more accomplished that way. But you really need your own work comp lawyer at this point.

    This answer is intended as general information and not as specific legal advice. If you want to have a free consultation with me, please contact me through AVVO.

  2. I will defer to the Calif attys here but in my state once there is an atty for the ins co the injured party, or their attorney, is supposed to only talk to the defense atty unless the adjuster authorizes you to talk the them instead of the attorney

  3. You need to hire an attorney of your own. You are not likely to make headway in the current situation without help.

    The above is not intended to be legal advice, but may be used for general information. Please contact an attorney for specific help tailored to your needs.

  4. I'm not sure what you mean when you say you file complaints against her, or write her up. To whom are you complaining? If you're just complaining to her supervisor or someone else at her employer, you're pretty much wasting your time. You don't have any control at all over her employment. You need to be doing what is legally necessary to get the treatment you need, and that has nothing to do with complaining about your adjuster. If you don't feel comfortable taking the legal steps necessary to get your treatment, you really need to get an attorney to handle your case for you. You can find good ones on this site, or at, the organization for attorneys who represent injured workers in California.

  5. You undoubtedly need representation. Insofar as ethical behavior of an insurance adjuster; what you have seemingly described is an adjuster unwilling to give you what you want or need. That is why there are hearings available to the claimant. It forces the employer/insurer to provide you with the care you need. An example of unethical behavior on the part of the adjuster would be to speak with you while represented without your attorney's consent. Remember, insurance companies will do almost anything not to pay you. That is why you need a good advocate in your jurisdiction.

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  6. Before I was a licensed attorney, I was a workers' compensation claims adjuster. Based on my experience, I would say that it is extremely rare for a workers' compensation defense attorney to be involved in a case where the injured worker is not represented by an attorney. Perhaps not so much for doing a "walk through" of a settlement after an agreement has been made, but in the day-to-day grind, there's no way an adjuster would have an attorney on the file. Their goal is to pay out what is owed an nothing more. It wouldn't be easy to justify the legal expenses on an unrepresented case.

    In other words, you should speak with your attorney. If the adjuster is doing something wrong, let your attorney handle it. If your attorney is not helping you, look for a more responsive representative. But for as long as you have an attorney, no adjuster will speak to you. Not because they are mean or incompetent. It's because they aren't allowed to speak to you, once you have an attorney.

    Just because you don't get a call back, doesn't mean the adjuster isn't doing her job. Perhaps she has sent requests through utilization review; and perhaps the requests were non-certified. These would all be great questions for your attorney.

    Best of luck to you.

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