Dealing with Workers' Comp Claim Adjusters 

Really ! Well my WC adjuster is different. My easy claim is going on for 2 months and still pending status! Because this adjuster sit on his ass! He never request medical records when he tells me he is waiting for medical records. Seriously , how can you expect something when you never requested. I have to wait in pain because of this lazy adjuster! HR is no help! Is there someone above the adjuster I can talk to.

It's hard to say whether you should see a QME, normally we would want to see what your treating physician wrote in their report before going the QME route. A QME can be good, but can also be bad for your case if you don't end up with the right one, or you already have a really good report from your treating physician! Normally provision for future surgery would increase the value of your case. Sometimes it can impact the rating as well if the rating estimate is based on a type of surgery (for example, there is a fixed percentage rating for a total knee replacement with a good outcome). If your doctor did not write that in their report, but it was something you talked about, you could always ask about it at your next appointment. If you really don't like your treating physician, you can also switch. Just ask your adjuster for the MPN link and you can choose a new doctor. As long as you have future medical needs, they cannot decline this. Dealing with multiple dates of injury can be difficult, especially when there are overlapping body parts and/or liability issues. We typically don't recommend settling one case and leaving others if there is overlap. That being said, every case is different and recommendations are very fact dependent.

Hi Venice, thanks for reaching out. There are many deadlines that are set within the workers' comp system. Unfortunately, many of those deadlines are used to the last second possible. We see this happening all of the time and it's frustrating. Keeping in contact with the Adjuster and calling in daily helps.

😂this mean … ain’t nobody can help!

Sorry for the delayed reply! In CA you can always terminate your attorney, generally at any time you see fit. Whether it's a good idea is a different question depending upon how far along in the case you are. It would be difficult for us to give you suggestions on how to move your case forward without knowing much about what is going on. If you are concerned about the handling of your case, you can always consult with other attorneys. At the very least, maybe they can help you determine whether your attorney needs to be replaced. The WCAB also has information and assistance, which is a department that works with unrepresented individuals to help them work their way through the system without an attorney. They are kind of like the workers' comp version of public defenders in some sense. Best of luck to you!

This happens a lot. If you are not satisfied, know you have options! Wishing you the best of luck.

Hi Samuel, thank you for asking. Short answer is No. Unfortunately, you can't fire your claims adjuster, but if your claims adjuster isn't doing their job you can always ask to speak with the claims manager or supervisor and/or ask to have another adjuster assigned to your file. This would be discretionary though. Surgery can impact your permanent disability rating insofar as treatment can reduce your functional impairment or make it worse. Depending on who your treating physician is, you may get a better disability rating going to a QME. But you also risk getting a lower rating depending on which QME you end up with if you aren't careful.

Thank you for sharing your thoughts!

I was batterd at walmartt and nobody nothing did anything about my TBI and neck injurys

Yep, happens all the time. Keep your finger on it. There are penalties and sanctions you can get for late payments. It's in our next episode, make sure to tune in.

@@WorkCompTalkPodcast will do. Saw a comment here that said go to the claims manager. Got the number and reported the issue. The adjuster sent me a tracking number 2 hours later !

Being on workers' comp for over 5 years is incredibly hard, we can just imagine what it's like being in it for 23 years. We do know the longer you are in it, the harder it gets to get anything approved and moved forward. Maybe it's time you seek help from somewhere or someone else? Wishing you the best of luck!

@@WorkCompTalkPodcast Just my luck, another dead end. Thank you so much for replying. Have a wonderful new year ... God Bless and keep you always amen.

Some adjusters may care but we all know what their job is so it's rare that you all do what's best for the injured worker.If that was the case then hearings wouldn't have to be scheduled as much as they are And people wouldn't need to hire attorneys as much as they do.

Agreed, they do not care, plain and simple. Denying claims with absolutely no proof because I know where and what injuries occurred. 30 years if dealing with you pricks!!

You don't care, trust me your assholes, all of you. My first Adjuster 30 years ago was aswome, but the last 3 have been un -willing to there job because they are denying medical claims that they claim happened in another accident and have not gotten those records, but I have and can prove they denied claims based off of no evidence!!