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Can I Sue My Workers’ Comp Adjuster?

Many workers are unaware that they can take legal action against their workers’ compensation adjuster, but there are certain situations where this may be possible. Workers’ compensation is meant to support injured employees, but complications can arise when adjusters engage in practices that delay or deny benefits. In this article, we’ll explore the circumstances under which an injured worker might consider taking action against a workers’ compensation adjuster. More about our workers’ comp lawyer here.

Can You Sue Your Workers’ Comp Adjuster?  

You can sue your workers’ compensation adjuster under certain circumstances. 

Workers’ compensation adjusters are responsible for evaluating and processing claims. If they mishandle your claim or act in bad faith—such as delaying payments, making lowball settlement offers, or denying necessary medical treatments—you may have grounds for legal action. If you believe the adjuster’s actions are unlawful, you can seek assistance from an attorney to file a lawsuit or take other legal steps to protect your rights and secure the compensation you deserve. 

Understanding Workers’ Compensation Adjusters

A workers’ compensation adjuster is responsible for managing claims, determining eligibility, and ensuring that injured workers receive the benefits they are entitled to, all while protecting the insurance company’s interests.

Adjuster’s Dual Role

The adjuster’s role is twofold. On one hand, they aim to ensure that the injured worker receives appropriate compensation. On the other, they protect the insurance company’s interests by minimizing payouts. This balance can lead to conflicts of interest, with adjusters sometimes prioritizing cost savings over fair compensation for injured workers.

Common Tactics Employed by Adjusters

Adjusters may use various tactics to limit claims, including:

• Delays: Prolonging the approval process to pressure workers into accepting less compensation.
• Lowball Offers: Offering settlements that are much lower than the worker’s actual needs.
• Recording Statements: Getting recorded statements from workers that can be used against them later.
• Hiring Private Investigators: Monitoring workers to find evidence that contradicts their claims.

Reasons to Sue a Workers’ Compensation Adjuster

Improper Claims Handling

An adjuster’s mishandling of a claim can significantly impact the injured worker. Common examples include:

• Delayed Payments: Payments that are made late or never issued, causing financial distress.
• Missed Deadlines: The failure to process claims within legally required timeframes.
• Disregarding Medical Advice: Ignoring or refusing to honor the worker’s doctor’s recommendations, leading to inadequate treatment.
• Denial of Necessary Treatments: Refusing to cover treatments that are essential for recovery, despite medical documentation.

Bad Faith Actions

Some adjusters engage in unethical behavior to reduce payouts. Examples include:

• Intentional Misrepresentation: Adjusters may intentionally distort facts or manipulate evidence to lower the settlement offer.
• Manipulating Statements: Misusing recorded statements or other communications to weaken the worker’s case and justify a reduced payout.

Retaliation

If a worker asserts their legal rights, the adjuster might retaliate by:

• Coercion: Pressuring the worker to return to work prematurely or accept a low settlement offer.
• Targeted Actions: Taking steps that harm the worker’s case, such as delaying claims or denying medical treatments.

Can You Sue the Adjuster Directly?

In most cases, you cannot sue a workers’ compensation adjuster directly. However, you can pursue legal action against the insurance company for bad faith practices. If an adjuster acts unreasonably—such as delaying payments or denying necessary treatments—you may have grounds to sue the insurer for acting in bad faith.

The Claims Appeal Process

If your claim is denied, you can file an appeal. The process involves submitting a formal request to have your case reviewed by a judge or board. Working with an attorney can improve your chances of a successful appeal by ensuring that all necessary documents are submitted and arguments are presented clearly.

Filing a Complaint

You can file a complaint against a workers’ comp adjuster with the Division of Workers’ Compensation (DWC). This involves submitting a formal complaint, such as the DWC Audit Complaint Form, detailing the adjuster’s misconduct. Filing a complaint does not immediately resolve your case but helps regulators monitor adjuster behavior.

What Happens After Filing?

After submitting a complaint, the DWC may investigate the adjuster’s actions. This can lead to consequences such as corrective measures, fines, or even termination of the adjuster’s position. However, you may not be informed of the specific outcomes of the investigation.

Understanding Your Options for Suing an Adjuster

If you believe your workers’ compensation adjuster is acting unfairly, there are steps you can take. While suing the adjuster directly may not be possible, you can pursue action against the insurance company for bad faith practices. You also have the option to appeal denied claims and file complaints against the adjuster. Working with an attorney can guide you through these processes and improve your chances of securing the compensation you deserve. If you face unjust treatment, legal action may be necessary to protect your rights. Reach out to a lawyer to explore your options.

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Workers’ Compensation

Workers’ Compensation Attorneys Stroudsburg PA

Workers’ Compensation Lawyer Stroudsburg PA

Workers’ Compensation Attorney Stroudsburg PA

Workers’ Compensation Lawyers Stroudsburg PA

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Personal Injury Attorneys Stroudsburg, PA

Personal Injury Attorney Stroudsburg, PA

Personal Injury Lawyers Stroudsburg, PA

Personal Injury Lawyer Stroudsburg, PA

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