In his latest article for The Legal Intelligencer, “Investigating the Claims Adjuster’s Investigation in Workers’ Comp Matters,” Pond Lehocky Associate Andrew Ruder suggests that more investigation should be done on insurance claims adjusters in workers’ compensation cases. The article was also featured by The Pennsylvania Association for Justice.

An insurance claims adjuster is a person at an insurance company that assesses the amount of compensation a person should be paid based on their claim. Andrew explains how directly after an insurance carrier is notified of a work injury, it is required by the Pennsylvania Workers’ Compensation Act that they investigate and make a decision on the claim within 21 days.

Andrew then explains how in certain cases, even when there are multiple witnesses and medical records of a work place injury occurring, that an injured worker’s insurance claim for workers’ compensation still gets denied.

“Unfortunately, this scenario has become a reality for many individuals who sustain work-related injuries in Pennsylvania and are denied the benefits they are owed without any explanation from the insurance carriers,” Andrew states in his latest article.

Andrew says that this problem occurs typically in two different ways. The first way this can happen is if the claim adjuster’s files and documents clearly reveal that an investigation was performed and compensability was established, but a denial of workers’ compensation was issued regardless. The second possibility is when documents reveal that the claims adjuster simply failed to perform any investigation at all before denying the claim outright, which is illegal and unethical.

Andrew suggests that in order to stop these injustices from happening, workers’ compensation claimant attorneys should start investigating the insurance claim adjusters’ investigation of workers’ compensation claims.

“The time is now to stop this common trend and begin investigating the adjusters’ investigation of workers’ compensation claims,” says Andrew.

To read the full article, click here.




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