Understanding the Role of Insurance Adjusters in Vermont Workers’ Compensation Cases
Several key figures are involved in the workers’ compensation claims process, one of the most important being the insurance adjuster. Understanding the role of the insurance adjuster in your Vermont workers’ compensation case can help you navigate the process more effectively and ensure you receive the benefits you are entitled to.
Below, we discuss the role of insurance adjusters in Vermont workers’ compensation cases.
Who Is an Insurance Adjuster?
Insurance adjusters are professionals employed by insurance companies to assess claims and determine coverage, liability, and the amount to be paid out. In the context of Vermont workers’ compensation cases, insurance adjusters handle claims filed by injured employees. These professionals assess the validity of claims and determine the benefits to be paid to employees.
What Is the Role of Insurance Adjusters?
Insurance adjusters manage claims from start to finish. They determine if a claim will be accepted or denied. To make this determination, adjusters;
- Investigate the Claim: Adjusters gather information about the accident or injury. They may review evidence, including accident reports and medical records, speak to the injured employee and their employer, and gather witness statements if necessary.
- Determine Whether the Claim Is Compensable: Generally, in Vermont, a workers’ compensation claim is compensable if the injury arose out of and in the course of employment. This means the injury must have happened while the worker was engaging in job-related duties or activities that benefit the employer. Additionally, Vermont law requires employees to report work-related injuries immediately or as soon as possible for the injury to be considered compensable.
Another vital role of insurance adjusters is communicating with all involved parties. Adjusters provide updates, answer questions, and request documentation.
Once a workers’ compensation claim is approved, the insurance adjuster is responsible for ensuring the injured employee receives timely wage replacement payments, approving medical treatments, coordinating doctor’s appointments, and tracking the worker’s recovery progress.
If a claim is denied and litigation follows, the adjuster remains actively involved. The adjuster will monitor treatment and recovery progress throughout the legal process, arrange evaluation with medical providers, and make settlement offers when appropriate.
Challenges Employees Face
Since insurance adjusters work for the insurance company, their goal is to settle claims cost-effectively. Because of this, injured employees may face challenges such as;
- Delayed or denied claims
- Underpayment of benefits
- Disputes over medical treatment
For example, if the insurance adjuster questions the legitimacy of the injury, they may delay or deny the claim.
How Can You Protect Your Rights?
The following are some of the steps you can take to protect your rights after suffering a work injury in Vermont;
- Reporting your injury immediately or as soon as possible
- Consulting a skilled workers’ compensation attorney
- Seeking prompt medical attention
- Keeping thorough documentation
- Following doctor’s orders
- Following legal deadlines
- Being cautious about what you share online as adjusters may monitor you online
- Staying informed about your case
It’s vital to note that you are not required to speak directly to an adjuster. Instead, you can hire an attorney to handle all communications. An attorney can protect your rights and increase your chances of recovering the compensation you deserve. If you do speak with an insurance adjuster, you must be honest.
Sluka Law Firm Is Here To Help
If you’ve been injured at work, contacted by an adjuster, or need help with any aspect of your claim, contact our Vermont workers’ compensation lawyer at Sluka Law PLC.
Source:
law.cornell.edu/wex/course_of_employment
