You suffered a sudden accident at work. You are hurting. You need treatment. Questions, worries and fears race through your mind. Will I heal? Can I keep my job? When can I see the doctor? How can I pay my bills? How does work comp work? I’ve heard all the questions. I’ve heard all the frustrations. I counsel injured workers almost every single day.
Today, I want to discuss one of the most common frustrations — The insurance adjuster will not respond or return your calls. Nothing is more frustrating! If you are hurt and frustrated by an adjuster who will not respond, you are not alone. In both Alabama car accident cases and workers’ compensation claims, this is a very common problem. Adjusters bombard you when they need something or when they are pushing you to settle for a small amount. When you need something, they disappear.
Why do insurance adjusters ignore your calls? Let’s look at four primary stages in a work comp claim when adjusters disappear. What are these four primary stages of a work comp claim? Why are you being ignored? How can you respond?
The Beginning — I Need To Get My Medical Care Started
In Huntsville (and across northern Alabama), many injured workers are initially sent to the Occupational Health Group (OHG) or some other small general practice clinic. These are the “gatekeeper” doctors. That’s what I call them. They are quick to drug test you. They are quick to discount your pain. They are slow to prescribe treatment you really need. Many patients with work-related injuries feel ignored by these gatekeeper doctors as well. I totally understand. It’s when you need real medical care, the specialized kind beyond the simple gatekeeper, that the adjuster disappears. This is when your calls are ignored!
Here’s an example. You hurt your back in an accident at work. After reporting the accident to the boss, your employer sends you to OHG. When you arrive at OHG, a drug test is the clinic’s top priority. If possible, the OHG doctors will initially diagnose your injured back as a simple sprain or strain. Many back injuries are sprains that will heal. But, some are not. The gatekeeper doctors often take the wait-and-see approach. This saves the insurance company money. Often, they take the wait-and-see approach too far. In those cases, you suffer without the help you need. If you continue hurting and the gatekeeper doctors refer you to a specialist, the insurance adjuster will often disappear. A referral should be simple. When the adjuster ignores the requests, it is not. Now, the adjuster won’t call, won’t email and won’t return any of your messages.
When you need a referral for real care, the adjuster disappears. If this (or something similar) happens to you, it’s very common. You have choices, including filing a lawsuit to fight for your benefits.
The Middle — I Need Specific Treatment To Complete My Recovery
Like the prior situation, this one also involves an issue of medical care. By now, you are seeing a specialist for care. Maybe the specialist has prescribed conservative treatment like physical therapy. However, you are still hurting. You are not getting better. In many of these situations, the specialist has mentioned surgery (or some other invasive treatment) as a possibility if you don’t heal. More and more, it looks like that surgery may be required.
When your doctor tries to contact the adjuster for authority to perform the needed surgery or other treatment, he cannot get a response. Calls from his nurses and staff go unanswered. Nothing! You get involved. Your calls and emails also go unanswered.
In both the “beginning” and “middle” stages, the adjuster disappears right when an issue of medical care arises. It’s not a coincidence. It’s all about cost. The insurance company wants to save medical costs at your expense. At some point, you may need to seek legal help to get the care you need.
The End — The Doctor Says I Reached Maximum Medical Improvement
At some point during your treatment, you may hear the doctor say the words — Maximum Medical Improvement (MMI). What is MMI? This means you have healed as much as you can. You may have heard the old expression, “you are as good as you are going to get.”
MMI does not mean you are fully healed. If you suffered a serious injury, you may have substantial limitations or disabilities after reaching MMI. You may never again be 100%.
If you are receiving temporary total disability benefits (TTD) in Alabama while healing, MMI is an important date. When you reach MMI, the workers’ compensation insurer can (and will) stop your TTD benefits. After all, your condition is no longer temporary. Now, you are permanently healed or permanently impaired to some degree. You may be eligible for additional benefits such as permanent partial disability (PPD) or permanent total disability (PT) benefits. But, you definitely cannot count on the insurance adjuster to offer the full benefits to which you may be entitled.
Often, the work comp adjuster simply disappears when the patient reaches MMI. I’ve listened to countless stories of injured workers where the case nurse and adjuster simply disappear at MMI. Calls and emails from the injured worker to his adjuster go unanswered. Why are you being ignored? First, the insurance company is hoping you stop seeking medical benefits. Yet, you are still entitled to medical care. Many patients need regular medical care to maintain their condition. Second, you may be entitled to more benefits as I mentioned in the prior paragraph. The adjuster may not want to pay you.
We recently filed suit for an Alabama truck driver who suffered a terrible injury at a truck stop. The injury left him very disabled. When he reached MMI, the adjuster simply quit returning any of his phone calls. Complete silence. He is entitled to additional benefits for his disability. The adjuster’s actions put a terrible financial and medical strain on his family.
If you are at MMI and suffer permanent disabilities or impairments, don’t let the adjuster ghost you. Seek the benefits available to you under Alabama law.
The Aftermath — The Adjuster Suddenly Disappeared After My Settlement
This is a terrible situation. Most of the blame lies with lawyers who advertise themselves as work comp lawyers. That’s right, I blame other injury lawyers for this problem.
What is the problem? You are hurt. You hire a personal injury lawyer. You make a comp claim. At some point, you settle your claim. As part of the settlement, you receive money benefits for your impairment or disability. And, you also receive continued medical benefits. Under Alabama comp laws, you are entitled to continued medical benefits. You expect to continue seeing the doctor for your injury as needed.
Everything should be fine. Often, the insurance company will wait. At a later point, the insurance adjuster may start ignoring the authorized doctor’s requests or ignoring your phone calls. Sometimes, the adjuster simply denies further treatment. When you call your lawyer for help, you get none. The guy you hired to help on your claim goes AWOL. Your own lawyer goes AWOL. This is common from advertising lawyers who have already received their attorney fee. And, it’s absolutely wrong. If you are a lawyer and take a workers’ compensation claim, you owe the person continued advice. I often tell our clients, we want to be your lawyers for life.
Do Not Let The Insurance Adjuster Ignore You
I’ve written this article about Alabama workers’ compensation benefits. It’s also common for adjusters to simply ignore the victims of car or truck accidents in Alabama. In car accident cases, adjusters will often badger injury victims for answers, authorizations, medical records and other information. Then, when it’s time to talk settlement, they disappear. Just like work comp cases, the adjuster disappears when the talk turns to an issue that may cost the insurance company. Don’t let an adjuster ignore you. Seek good advice from a lawyer who will file and pursue your claim in court if needed.
The Blackwell Law Firm helps injured workers across Alabama. Check out our website and blog for articles about accident and injury law in Alabama. You can also call us with your questions. Consultations are always free and confidential.