Health Care

Why is claim adjuster not calling me back or responding to my emails?

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Why is claim adjuster not calling me back or responding to my emails?

I often receive phone calls from injured workers because the adjuster is not returning phone calls or responding to emails. In many of these situations I hear from the injured worker that everything was going okay until the claims adjuster stopped returning phone calls and responding to emails.

There are several reasons why this situation may happen:

1. There was a change to the adjuster handling the claim but notice of this change was not provided to the injured worker.

Many insurance companies will have an adjuster assigned to the claim during the investigation period following work injury to gather information and make a decision on accepting the claim and initiating benefits or denying the claim and refusing to provide benefits for the injury. Once this decision is been made the file may be transferred to another adjuster who will address the benefits. The file could be transferred to another adjuster if the case is denied and the claim moves forward to a hearing before the N.C. Industrial Commission. All too often, these transitions are not communicated to the injured worker.

Other times, the lack of communication is because the adjuster is no longer working for the insurance company. From time to time, I receive notice that an adjuster has left one insurance company to work for another insurance company. In these situations, the injured worker is sometimes the last person to find out about this change.

Sometimes, I am involved in the injured worker’s claim to address the issue and make sure lines of communication are restored to avoid significant delay in the claim.

2. There are certain benefits at issue in the injured workers’ claim and the insurance company is waiting to see if the injured worker pursue the benefits.

Some potential clients tell me that the insurance company was providing benefits and there were no issues until a recent Doctor’s appointment and then the adjuster failed to return phone calls or respond to emails.

In some instances when an individual is injured at work, the insurance company will begin benefits, both weekly checks and medical treatment, but only on a conditional basis while they investigate the claim. Sometime the willingness of the insurance company to provide conditional payment of benefits ends when the treating Doctor recommends surgery or removes the injured worker from all work.

The failure to respond to the injured worker’s phone calls or emails could indicate that insurance company/claim adjuster is waiting to see if the injured worker is willing to push this issue by retaining an attorney to address these issues and possible benefits owed with the N.C. Industrial Commission.

I encourage injured worker’s in this situation to reach out to an attorney in order to receive advice on their legal options in pursuing the possible benefits owed in order to understand the options in addressing the possible benefits at issue in their claim. I am always willing, at no cost, to talk with a potential client about these options.

3. The insurance company has retained an attorney to represent the insurance company regarding the injured worker’s claim.

In a workers’ compensation claim any time a party or the other retains an attorney, that party will no longer communicate with the other party and the attorney will address any further communication between the parties.

In some circumstances, the fact that the insurance company has retained an attorney could be a sign that they expect contested issues or the denial of benefits and the insurance company is retaining counsel to represent them before the N.C. Industrial Commission in term of these issues.

Any time an insurance company has retained any attorney in the injured worker’s claim I always recommend the injured worker at least speak with an attorney about the facts of their case and possible contested issues in order to understand their legal rights and possible actions the attorney for the insurance company could take regarding the injured worker’s claim.

If you ever experience any of these issues, have any questions about these issues or to speak with any attorney about what legal rights you have regarding these issue, please feel free to contact Cardinal Law Partners in order to have a free consultation and speak with one of our board certified workers’ compensation specialists.