What you should or should not say to a workers’ compensation claims adjuster before you hire an attorney?

To understand what you should or should not say to an adjuster before you speak with an attorney, you should understand what their position is in the case and why that matters. An insurance adjuster is the representative of an insurance company, and insurance companies, for the most part, operate as businesses trying to make a profit. And how does a business make a profit? They increase premiums, and they reduce expenses. So to the extent that an insurance adjuster can question you in a way to reduce that insurance company’s expenses, that insurance adjuster is doing their job for their employer. Doing their job is not beneficial to your case, and as such, be very suspect of what you say and don’t say to an insurance adjuster. With that warning and caveat, we are not upset that our clients have spoken with an adjuster early on in the case as long as the conversation is respectful and limited to very specific issues.

After a workers’ compensation claim is filed, an insurance company or employer has an obligation to investigate the claim and determine if it’s work-related. Consequently, basic questions around how you hurt yourself on the job are generally acceptable. With questions about how the injury arose, though, from the basic big picture item to, I was picking up a box into more specific and detailed questions about what your employer told you to do, what your employer told you not to do. Did you do this? Could you have done that? That’s the time in the questioning that you should cut off all that discussion and speak with an attorney.

Likewise, when the adjuster asked you questions about your body parts and was hurt, generic responses to those questions are appropriate. There’s nothing wrong with saying you hurt your back versus your foot. Those are logical questions so the adjuster can understand the nature of your claim. The gray area about injury questions is when the adjuster exceeds that scope of what’s hurting you now and starts getting into pre-existing injuries or things that might have caused pre-existing injuries.

Red flags are when they ask you what you do for hobbies, what did you do in the past? Have you ever been in a car accident before? Those are red flags that they are trying to dig up information adverse to your case, and you should end that conversation right away. An additional red flag that you have gotten yourself into a conversation with an adjuster who exceeds his or her scope is when they are talking about different body parts. For example, you hurt your arm on the job. You’re making a complaint about your arm, and they’re asking you to sign a release that would let them get your OB records. That’s clearly outside the scope, and that’s when you probably should speak with an attorney. Similarly, you hurt your arm, and they’re asking you for records about a car accident that happened 25 years ago. That’s clearly a red flag that an adjuster is on a hunt to try to find ways to deny the claim, and you should seek an attorney. 

In short, when you’re talking about the accident itself, what gave rise to the injury, very generic basic questions about what you were doing at the time that hurt your back, or hurt your leg, or whatever might be are appropriate. But the more detailed they become, the more the red flag is that you should, in that conversation, immediately seek counsel because they are apparently trying to dig to find a different cause. Likewise, if an adjuster sends you a release for records and they have not limited that release for prior records to your body parts or to a limited timeframe such as five or ten years. That’s another red flag that the adjuster is looking for something to try and deny your claim.