If you Google ‘Can I Trust the Workers’ Compensation Adjuster?’, you’re going to come YouTube videos with titles like ‘The Workers Comp Insurance Adjuster Is NOT Your Friend!’ as well as scores of Reddit threads that pretty much say the same thing. But how true is that?
When you suffer a workplace injury in Georgia and file a claim, a representative from the insurance company will likely contact you. Speaking in a calm, courteous tone, they may say that they’re here to “help you through your claim.” But who are they really helping?
The short answer is that the adjuster answers to the insurance company that provides coverage for your employer. That friendly voice on the phone is backed by a system built to minimize costs. If you’re not careful, you may accept less than you’re owed or agree to an arrangement that puts your recovery at risk. Knowing the adjuster’s priorities (and your rights under Georgia law) can change how your insurance claim unfolds.
The Adjuster’s Role in a Georgia Workers’ Comp Claim
Workers’ compensation claims adjusters manage claims on behalf of the insurer. Their responsibilities include:
- Reviewing work-related injury reports
- Coordinating with physicians
- Approving or denying benefits such as medical treatment, temporary disability pay, and permanent impairment compensation
In Georgia, these decisions are subject to the rules outlined by the State Board of Workers’ Compensation and laws enacted by the Georgia legislature, but that doesn’t mean the adjuster is impartial. Their job is to control costs and close injury claims as efficiently as possible. That means they will probably challenge the severity of your injury, restrict the type of treatment you receive, or push for an early return to work, all so that they can better protect the insurer’s bottom line.
Some workers’ compensation adjusters arrange for second opinions from physicians who are known to understate on-the-job injuries. Others may question whether your injury even occurred at work and even suggest you have a pre-existing medical condition. These strategies can all delay the medical care you need or cut off your workers’ comp benefits when you need them the most.
Keep in mind that the adjuster is also tracking the overall cost of your injury claim. This includes not only your medical expenses and weekly payments but also any future exposure the insurance provider may face. If your injuries are likely to lead to long-term work restrictions or permanent disability, the adjuster may try to minimize those risks early, sometimes by pushing you into treatment options that resolve your claim on paper, even if they don’t improve your current condition.
Can You Count on the Adjuster to Be Honest?
Some workers’ compensation claim adjusters maintain a polite tone. Others don’t return calls or provide clear answers. But tone doesn’t determine truthfulness. It is important to remember that the adjuster is not working for you. Even when they sound helpful, their recommendations may be shaped by what’s best for the workers’ compensation insurance company, not what is best for you. Here are some things you need to know when you’re filing a workers’ compensation claim in Georgia.
They May Schedule Your Medical Treatment
Georgia law (under O.C.G.A. § 34-9-201) requires employers to post a valid panel of physicians. The panel of physicians is basically a list of workers’ compensation doctors chosen by your employer. You have the right to choose your treating doctor from that list and also have some limited rights to change doctors. The problem is that adjusters often schedule medical appointments without explaining your right to select a provider, or they guide you toward physicians known to limit diagnoses.
They May Delay or Interfere With Your Workers’ Compensation Benefits
Another issue involves income benefits. If your injury keeps you from working, you may be entitled to temporary total disability (TTD) payments. Adjusters may suggest these payments aren’t available or delay the first check to discourage you from filing a formal claim. If you’re relying on their word, you may accept less than what you’re eligible to receive.
They May Set the Narrative About Your Medical Care
Adjusters also control the communication between your doctors and the insurer. When physicians submit treatment requests, the adjuster can approve or deny them, usually without any input from you. If a surgery is recommended or physical therapy is needed, that request goes to the adjuster for review. In many cases, the injured worker isn’t even told when something is denied unless they ask. This one-sided arrangement allows adjusters to shape your recovery timeline behind the scenes, leaving you with delays and unanswered questions.
What the Adjuster Might Not Tell You
Even when an adjuster seems helpful, they tend to leave out information that could make a difference in your claim. If you’re not aware of your rights under Georgia law, it’s easy to miss important options that could affect your medical care, benefits, or ability to respond if something goes wrong. For example:
- You’re not required to give a recorded statement to the insurance company. These interviews often happen early, before you’ve spoken with a Georgia workers’ compensation lawyer, and can be used to limit or deny your claim later.
- You have the right to challenge a denial of treatment or a suspension of benefits through the Georgia State Board of Workers’ Compensation.
- The adjuster may not explain how to act if your condition worsens or your employer pushes you to return to work too soon.
- In some cases, your employer’s posted panel of physicians may not comply with legal standards. If that happens, you may be able to seek treatment with any physician you choose.
All of the above is true, but whether the workers’ comp adjuster voluntarily discloses this information is another matter.
Signs the Adjuster Is Working Against You
Sometimes, it’s clear the adjuster isn’t being upfront. Other times, the warning signs are subtle. If you notice any of the following, it may be a sign that the adjuster is putting the insurance company’s interests ahead of your health and recovery.
- Your medical treatment is delayed without explanation or the adjuster won’t return your calls.
- You’re discouraged from contacting a lawyer or told you don’t need one.
- You’re asked to sign forms without being told what they do or how they affect your rights.
- You’re pressured to take on light-duty work or return to your job before you’re medically cleared.
- You’re sent to independent medical exams (IMEs) that contradict your treating doctor’s opinion, and the adjuster uses them to deny care.
What You Can Do to Protect Yourself
You don’t have to accept the adjuster’s decisions without question. Taking a few basic steps like the ones outlined below can help you keep control of your claim and protect your right to fair treatment.
- Keep complete records of every phone call, appointment, and email related to your injury.
- Request copies of medical records, forms you sign, and any written communication from the insurance company.
- Confirm that your employer’s posted panel of physicians meets legal standards. If it doesn’t, you may be entitled to choose your own doctor entirely.
- Speak with a legal professional before signing anything that could impact your right to medical care or weekly wage loss benefits.
- Track your symptoms, medical instructions, and missed workdays in a journal. This record can be used later if your case is disputed.
Why Hiring a Georgia Workers’ Compensation Attorney is Strongly Recommended
Hiring an experienced lawyer doesn’t mean that you’re going the adversarial route. You’re simply protecting yourself and your wellbeing. Once you have legal representation, your attorney handles all communication with the adjuster, makes sure deadlines are met, and holds the insurer accountable for workers’ comp benefits that are owed.
At Perkins Studdard, we specialize in helping injured workers in workers’ compensation claims. We’ve seen insurers delay care, push workers back on the job prematurely, or offer low settlements before medical treatment is complete. These practices are unfair but extremely common, and we’re ready to challenge them.
When you’re represented by an experienced attorney, you’re no longer left to interpret confusing forms or justify your injury pain to someone who benefits from denying it. We gather the workplace accident reports and medical history, consult with authorized physicians, and make sure your case is positioned properly under Georgia workers’ compensation law.
Having a workers’ comp attorney also makes it more likely that your claim will be taken seriously by the insurer. When a lawyer is involved, adjusters are less likely to ignore requests, delay approval for treatment, or try to close a case early. Instead of managing these complications yourself, you’ll have someone who knows the rules and can enforce them.
When to Call a Workers’ Comp Lawyer About Your Adjuster
While we recommend that you always speak to a workers’ comp attorney about your benefits claim, especially if your work-related injuries are serious, some situations call for immediate legal help. If you’re dealing with delays, denied treatment, or pressure to return to work before you’re ready, it’s time to speak with someone who can step in on your behalf.
Common challenges include:
- Your checks stop suddenly
- The workers’ comp insurer delays or denies your medical care.
- You’re being asked to return to work while still in pain or without medical clearance.
- The adjuster seems dishonest or is avoiding your questions.
- You’re unsure how to respond to a request or decision and want someone to explain your options.
- You feel you’re not receiving the benefits you should for your injury.
What to Expect If You Take Legal Action
The insurance company has attorneys and adjusters who specialize in workers’ compensation and will try to make the system work best for the insurance company. Hiring a workers’ compensation attorney means you have someone on your side to fight for your best interests and to make sure you receive the benefits to which you are entitled.
The Georgia workers’ compensation system is designed to provide you with medical treatment to recover from your injury and wage loss benefits to keep you afloat while you cannot work. When you hire a workers’ compensation attorney to represent you, that attorney will make sure the insurance company follows the Georgia workers’ compensation laws and rules. The attorney will also give advice about the difficult decisions you must make in your case from choosing a doctor to settlement and everything in between.
Don’t Let the Insurance Adjuster Control the Direction of Your Claim
The workers’ compensation adjuster may sound helpful, but their first loyalty is to the insurance company. Their job is to close claims quickly and reduce expenses. That often leads to delayed treatment, denied benefits, or early return-to-work demands that ignore your condition.
If you’re dealing with an adjuster who won’t answer your questions or approve the care you need, it’s time to act. At Perkins Studdard, we’re here to ensure your voice is heard and your rights are respected. Call us today at 770-214-8885 or send us a message online to schedule your free consultation. Don’t wait until your benefits are cut off or your injury gets worse – get legal advice from a workers’ compensation specialist today. The earlier you act, the stronger your position becomes, and the harder it is for the insurance company to control the outcome.
