Your adjuster must reside in Montana
Many insurance companies write coverage in Montana but that doesn’t mean those companies have offices here. In some states, it is permissible for an adjuster to handle claims from anywhere in the country. That is not true for Montana. Any insurance company handling workers’ compensation claims in Montana but have a Montana-based adjuster. Read the Court’s comments on that HERE.
Have your claim information on hand
Adjusters have a lot of claims, so do not be surprised or let your feelings get hurt if they do not remember your name or the details of your injury without looking it up. Not wasting their time will help them help you.
Be honest but complete when talking with the adjuster
If they ask you about activities, be complete in your description. Saying you “went to the gym” could mean a thousand different activities. If you are not clear, they will not know.
Understand that the adjuster is reacting to the information they have learned from your medical notes
Anything you say to your doctor could end up in the medical note that an adjuster is reading. If there is something specific mentioned about your notes, ask the adjuster to read it to you.
Stay calm when you talk to your adjuster – NO verbal abuse
It is okay to express frustration. But yelling at your adjuster will not help. If anything, a conflict like that makes talking to them even harder. That will make it harder for you to get answers, especially if you need them quickly. Verbally abusing the adjuster will result in an adjuster hanging up on you followed by a letter kindly asking you to put anything you have to say in writing.
Questions are good. Calm questions are better
Be specific when asking for information. Calm questions are an effective way of getting the information you want. Unless you have the same adjuster for years and years, the decisions an adjuster makes on your claim are usually not personal. A good adjuster understands that those decisions impact you, your livelihood, your ability to work, pay bills, and take care of your family. They know it is personal to you, but the reality is that it is not personal to them. It’s just a job, and most adjusters are trying to do it the way their bosses have asked them to do it.
What if the Adjuster Wants a Recorded Statement?
If the adjuster asks for a recorded statement, don’t freak out. The recorded statement is becoming more commonplace. You are not required to give a recorded statement. You can tell the adjuster to look at your First Report of Injury for information. If you decide to do it, make sure they will give you a copy of the transcript beforehand. If they refuse, don’t do it. Or just say NO.
How to write a letter to your adjuster that actually gets read
Writing a letter to your adjuster can be a good idea if you are worried that your words will be mischaracterized or twisted in some way. Do your best to write and speak clearly with the adjuster.
Keep a copy of your letter. Type it if possible. But, either way, make it easy to read. A letter that is one or two full, handwritten pages, and without paragraphs is not likely to be read.
What the adjuster is looking for during the investigation
The adjuster is taking a close look at your medical records to see if what you reported to your doctor about your injury matches what you said in your First Report. If the stories match, you’re in good shape. If the stories don’t match, or if the medical notes don’t say anything at all, then your claim will hit a rough patch. It doesn’t mean you’ll see a denial, but it may take a little longer for the adjuster to conclude that your claim should be accepted.
If all three of the parts of the investigation are not complete, the adjuster may deny your claim or hold off on deciding. If you don’t speak with the adjuster or they don’t receive your medical notes from your first visit to the doctor, you will most certainly see a denial. The burden is on you to make sure the medical records get provided to the adjuster.
The Adjuster has 30 days to conduct an investigation once getting the claim
Once the adjuster gets your claim, they do an investigation. In most circumstances, the adjuster has 30 days to investigate and decide on whether to accept or deny your claim. In some cases, they can get more time or not decide at all. Missing the 30 deadline doesn’t really have a penalty but most adjusters still try to meet that deadline.
Conclusion: Stated plainly – the adjuster’s job is to get you in and out of the work comp system as quickly as possible at the lowest possible cost. Some adjusters can do that fairly, but many cannot. When your adjuster has to make a choice, you should remember who their priority customer is – and that’s the policyholder (your employer). NOT you.
If you want to learn more tips about your Montana work comp claim and the Montana workers’ compensation system, you can download our free book, Hurt at Work: An Insider’s Guide to Understanding your Montana Work Comp Claim” by going to the main page of our website: https://mtworkcomplawyer.com.