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How Workers Compensation Adjusters Decide Settlements

When you get hurt at work, you suddenly become a part of this strange system known as workers compensation.  One part of that system that becomes apparent quickly is the individual known as the workers compensation adjuster.

You quickly learn that the adjuster makes many of the decisions that affect everything about your injury.  In particular, many people experience the following when dealing with their workers compensation adjusters:

  • The adjuster tells them what doctor they can see
  • The adjuster tells them what time they can go to the doctor
  • The adjuster decides when to send their workers compensation check
  • The adjuster checks in on all aspects of their case
  • The adjuster decides whether treatment recommended by their doctor gets approved

These are just a few of the things that adjusters try to do.  Sometimes, adjusters work in tandem with nurse case managers when it comes to medical treatment and testing.  This pairing of adjuster and case manager can make it difficult to understand which person is responsible for which decision.

Also, the fact that an adjuster does something does not necessarily make it right.  For example, the law does not really empower adjusters to tell you which doctor you get to see.  You actually have some choice when it comes to your workers compensation doctor.  Be sure and check on your rights before just taking the adjuster’s word for it.

Insurance adjusterDoes the adjuster decide my workers compensation settlement?

The answer to this question is “Yes” and “No”.  So, how can that be?

Adjusters generally have the power to decide how much they will offer you to settle your workers compensation case.  In other words, adjusters will make decisions about the most they are willing to pay to settle.  Depending on the insurance company and the amount of the settlement, adjusters sometime need other individuals at the insurance company to decide about higher settlement amounts.

Since adjusters decide on how much they are willing to offer, they do “decide your settlement” in some sense.  But, they do not get to decide how much you are willing to accept to settle your case or even if you are willing to settle your case at all.  Since you get to decide those things, the adjuster does not really decide your settlement.  But, their ability to decide how much they will offer determines what the range of your settlement will be.

How does the adjuster decide how much they will offer to settle my case?

Adjusters work for insurance companies.  The insurance companies are trying to make money.  Your workers compensation case costs them money when they have to pay out money on it.

Part of the adjuster’s job is to try to save the insurance company money.  When it comes to settlement, the insurance company has two options.

  1. They settle your workers compensation case
  2. They do not settle your workers compensation case

The reason they have these two options is because settlement is not required.  So, the insurance company can just choose to keep your case open and not settle with you.

Because this is one of their options, the insurance company will consider how much that option will cost them.  This estimated cost of keeping your case open in the future is one of the main factors that determines much they will offer in settlement.

An example may help to explain this better.  Let’s say your case was going to cost the insurance company $100,000 in the future if they did not settle with you.  In this scenario, an insurance company should be willing to pay up to around $100,000 to settle your case because they think doing so would have them break even.  They would obviously prefer to pay less than $100,000 because it would save them money, but they would not pay more because they would just choose to leave your case open.

So, a large part of what the adjuster does in evaluating your case for settlement is determining how much your case is going to cost in the future if it stays open.  That is almost always the primary motivating factor in the amount an adjuster is willing to offer in settlement.

Can the adjuster change their mind about how much they are willing to offer in settlement?

Yes.  I have had many situations where adjusters change their mind and are willing to offer more than they initially wanted to offer.  This often happens because some new information shows the adjuster that the amount they were originally wiling to offer does not really take into account how much the case will cost the insurance company in the future.

Convincing adjusters to offer more money in workers compensation settlements requires an expert understanding of the benefits available in a Georgia workers compensation case.  It will not do any good to talk with the adjuster about pain and suffering and other benefits that are not covered by Georgia’s workers compensation laws.  Instead, it is important to understand what benefits are available and how long the insurance company will likely have to pay those benefits.

Perkins 274 Edit compressedIf you or your attorney do not fully understand Georgia’s workers compensation laws, then one of two things will likely happen:

  1. You will not receive the full amount that the insurance company was willing to offer
  2. You will not convince the insurance company to offer more money if the amount they were willing to offer is too low

The reason failing to fully understand Georgia’ workers compensation laws could result in not receiving the full amount the insurance company would offer is that you will believe the insurance company’s arguments about your future workers compensation benefits.  If you do not understand how long you will likely receive benefits if you do not settle, then you could likely end up accepting a smaller settlement than you should.  The insurance company will like this because it saves them money.

Likewise, not understanding how the Georgia workers compensation system works prevent you or your attorney from convincing the insurance company that they should offer more money in settlement.  Understanding how all of the different parts of the workers compensation law interact will allow you to point out to the insurance company when they are wrong in the arguments they make.  When it comes to settlement, this provides you with the best chance of getting the insurance company to offer as much as possible.

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families. To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

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Jason Perkins

Workers' Compensation Attorney

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