After you’re injured at work, one of the first people you’ll deal with is a workers’ compensation claims adjuster.
They’ll call you, ask questions about your injury, and tell you they’re there to help. Many injured workers assume the claims adjuster is on their side, working to get them the benefits they deserve.
Here’s the truth: the claims adjuster works for the insurance company, not for you.
While they might be friendly and professional, their job is to protect the insurance company’s interests, which often means seeking out ways to pay you as little as possible.
Understanding what claims adjusters really do and why you need your own advocate explains why so many injured workers hire work injury attorneys.
What Does a Claims Adjuster Actually Do?
A workers’ compensation claims adjuster is assigned to your case after you report a workplace injury. Their official role is to investigate and evaluate your claim to determine what benefits you should receive. They act as the main point of contact between you and the insurance company throughout your case.
On the surface, their responsibilities sound reasonable and even helpful. They investigate the incident by gathering information about how you got hurt. They record your statement and talk to witnesses and your employer. They review your medical reports and coordinate with doctors. They determine if your claim is valid and calculate how much the insurance company should pay.
Claims adjusters also handle the practical aspects of your claim. They arrange medical appointments, approve treatments and surgeries, and process your benefit payments. They’re supposed to ensure your claim follows state laws and company policies. In many cases, they’ll negotiate settlement offers with you.
This all sounds like they’re helping you, right? The problem is that every decision they make affects the insurance company’s bottom line. The less they pay you, the better it is for their employer.
The Claims Adjuster Works for the Insurance Company, Not You
This is the most important thing to understand about claims adjusters. They are employees of the insurance company or independent contractors hired by the insurance company. Their performance is evaluated based on how well they manage claim costs and protect the company’s financial interests.
Insurance companies have one primary goal: minimize what they pay out on claims. Claims adjusters are the frontline workers who make this happen. They’re trained to find reasons to deny claims, reduce benefit amounts, and settle cases for as little as possible.
Let’s be clear. Most claims adjusters are good people doing their jobs professionally. They’re not necessarily trying to be unfair or dishonest. But their job requires them to prioritize the insurance company’s interests over yours. When there’s a question about whether you deserve certain benefits, they’re motivated to decide against you. When there’s uncertainty about how long you need treatment, they’re inclined to cut it off sooner rather than later.
How Claims Adjusters Protect Insurance Company Interests
Claims adjusters use several tactics to minimize what insurance companies pay on workers’ compensation claims. Understanding these tactics helps you see why you need your own advocate.
They control the information flow. Claims adjusters decide what information gets included in your file and how it’s presented. They might emphasize details that make your claim look questionable while downplaying evidence that supports your case. You won’t even know this is happening because you don’t see how they document your case.
They use your statements against you. When a claims adjuster calls to get your statement about the accident, they’re not just gathering facts. They’re looking for inconsistencies, admissions, or comments they can use to deny or reduce your claim. Something as simple as saying “I’m feeling a bit better” could be used to argue you don’t need continued treatment.
They send you to their doctors. In most states, including Florida, the insurance company gets to choose which doctors you see initially. These doctors know who’s paying their bills. While most are ethical professionals, some tend to minimize injuries or rush workers back to work before they’re fully healed.
They pressure you to settle quickly. Claims adjusters often contact injured workers early in their recovery and offer quick settlements. These offers are usually far less than what your claim is actually worth, but they count on you being desperate for money and unfamiliar with your rights.
They delay and frustrate. Sometimes, claims adjusters use delay tactics, hoping you’ll give up or accept less. They might be slow to approve treatments, take weeks to process paperwork, or require endless documentation. The frustration is intentional.
They question everything. Claims adjusters routinely question whether your injury is really work-related, whether you need the treatment your doctor recommends, and whether you’re actually unable to work. They’re trained to be skeptical of injured workers’ claims.
Why the System Puts You at a Disadvantage
When you’re injured at work, you’re already dealing with pain, medical appointments, financial stress, and worry about your future. You’re not thinking clearly about legal strategy or negotiation tactics. You probably don’t know workers’ compensation law or what benefits you’re entitled to receive.
Meanwhile, the claims adjuster handling your case does this every single day. They manage dozens or even hundreds of cases. They know the law, the procedures, and the tactics that work to minimize payouts.
They have training, experience, and resources you don’t have.
It’s not a fair fight. You’re an injured worker trying to navigate a complex legal system while dealing with serious injuries. They’re insurance professionals whose job is to pay you as little as possible. The system is designed to favor insurance companies, and claims adjusters are experts at working that system. It’s why it’s so important to have an experienced workers’ compensation lawyer on your side.
How a Work Injury Lawyer Levels the Playing Field
This is where a work injury attorney makes all the difference. When you hire an experienced workers’ compensation lawyer, you finally have someone on your side who understands the system as well as the claims adjuster does.
We communicate with the claims adjuster for you. You don’t have to worry about saying the wrong thing or having your words twisted. We handle all communication with the insurance company, protecting you from the tactics they use against unrepresented workers.
We know what your claim is really worth. Claims adjusters often offer settlements that sound like a lot of money but actually fall far short of what you deserve. We know how to calculate the true value of your claim, including future medical expenses and wage losses you might not have considered.
We gather evidence that supports your case. While the claims adjuster is building a file that protects the insurance company, we’re building a file that proves your case. We gather medical records, witness statements, employment records, and expert opinions that show the full extent of your injuries and your need for benefits.
We challenge unfair decisions. When a claims adjuster denies your claim, cuts off your benefits, or offers an inadequate settlement, we fight back. We know how to appeal denials, present evidence at hearings, and argue your case effectively.
We deal with their doctors. If the insurance company’s doctor minimizes your injuries or clears you to return to work prematurely, we can challenge those opinions with medical evidence from your treating physicians or independent medical exams.
We hold them accountable to the law. Claims adjusters sometimes violate workers’ compensation laws or fail to follow proper procedures. We know what they’re required to do, and we make sure they do it. When they don’t, we use their violations to strengthen your case.
The Claims Adjuster’s Skills Work Against You Without Representation
Remember those key skills and qualifications that make claims adjusters effective – Strong analytical skills, excellent communication, organizational abilities, and knowledge of insurance law. All of those skills are used to minimize what you receive.
Their analytical skills help them find weaknesses in your claim. Their communication skills help them get you to say things that hurt your case. Their organizational abilities mean nothing falls through the cracks when they’re building a case against you. Their knowledge of workers’ compensation law tells them exactly how little they can offer while staying within legal boundaries.
When you have your own attorney, these same skills work for you instead of against you. We use our analytical abilities to find strengths in your case and weaknesses in the insurance company’s position. We use our communication skills to present your case persuasively. We use our organizational skills to build a comprehensive record that supports your claim. We use our legal knowledge to get you every benefit the law provides.
Don’t Face the Claims Adjuster Alone
Claims adjusters are trained professionals whose job is to protect insurance company profits. They’re good at their jobs, which means they’re good at minimizing what injured workers receive. The friendly adjuster who calls asking how you’re feeling is not your friend. They’re gathering information to use against you.
You deserve to have someone on your side who’s just as skilled, just as knowledgeable, and just as committed to your interests as the claims adjuster is to the insurance company’s interests. A work injury lawyer provides that advocacy.
If you’ve been injured at work, don’t try to navigate the claims process alone. Contact an experienced work injury attorney before you give statements to the claims adjuster, before you sign anything, and before you accept any settlement offers. We’ll protect your rights, fight for fair treatment, and make sure you get all the benefits you deserve.
The claims adjuster has the insurance company backing them up. You should have an experienced attorney backing you up. Contact us today for a free consultation about your work injury claim. Call Adam Baron at 954-247-HURT now for a Free, No-Obligation Case Review.
Speak with a Florida Workers’ Compensation Lawyer
The bottom line: if you’re injured on the job, act quickly. Report your injury, put it in writing, and don’t assume it will “work itself out.”
And if your employer doesn’t follow through with their responsibilities, you don’t have to go through it alone.
At Adam Baron Law, we’ve helped countless Florida workers navigate the claims process and protect their rights. A quick consultation can make the difference between a smooth claim and one that gets denied. If you’re dealing with a workplace injury, or just have questions, reach out today for a free case review.
The Law Offices of Adam Baron, P.A. have represented hurt workers and accident victims for over 30 years. We understand how frustrating and challenging this time can be and we know how to help you through it. Our Florida work injury attorneys are aggressive when it comes to obtaining compensation and justice on behalf of our clients. We help injured workers all across Florida, including Ft. Lauderdale, Boca Raton, Miami, Coral Springs, Delray Beach and many others areas.
If you were injured or became sick while working, we can help. Call Adam Baron at 954-247-HURT now for a Free, No-Obligation Case Review.