Tips, tricks and advice for talking to an insurance company
after an on-the-job injury
A common question we receive is:
Do I have to talk to the insurance company after I have been hurt on the job?
The answer is fairly straightforward. No, you don’t have to talk to an insurance company.
However, there are important steps you should take after an injury. And there are reasons to talk — and not to talk — to an insurance company. In this article, we’ll explore what to talk about with insurers, as well as what not to talk about, after an on-the-job injury.
One person you should always speak with after a serious work-related accident or injury is an experienced workers’ compensation attorney near you. If you were hurt in Atlanta, Athens or elsewhere in Georgia, consult with the experts at Gerber & Holder Law.
Important steps and deadlines after a work-related injury
When someone is hurt at work, they are required by law to report their injury to a supervisor. The statute of limitations on reporting an injury is 30 days after an accident. You can report your accident to a coworker and/or a supervisor.
Additionally, if the injury is not a sudden one, but one due to repetitive activities or one that takes over time, the notification requirements are a bit different, but someone has to be informed of the pain/injury.
It is the duty of the employer, not the injured worker, to report a workplace injury to the workers’ compensation insurance carrier.
Unfortunately, this doesn’t always happen. Sometimes, the insurance company isn’t aware of the incident until after a claim has been officially filed with the State Board of Workers’ Compensation.
After reporting an injury, an injured worker has 1 year to file a claim (pursuant to O.C.G.A. 34-9-82), unless benefits have been provided. If medical treatment has been paid for by the insurance company, the injured worker has 1 year after their last treatment was paid by the carrier to file a claim. If indemnity benefits are paid, the injured worker has 2 years from the last date of payment of benefits to file a claim to “toll” the statute of limitations.
What to know about insurance companies before you speak with an agent
After the injury has been reported, either by the employer or via a WC-14 notice of claim, the insurance company will start gathering information about the accident. They may interview the employer and coworkers of the injured party. Additionally, the injured worker will usually be contacted by a representative of the insurance company.
This is a stop and freeze moment.
Understand that the insurance agent is working for their employer, the insurance company. No matter what their title is, their employer is the insurance company. They may identify themselves as an “adjuster,” a “case manager” or even an “injured victim advocate.” But make no mistake, they are gathering information on behalf of the insurance company. Anything you say to them will be used to determine whether or not the insurance company will begin payment of your claim.
Tips for speaking with an insurance representative
about your work-related injury or accident
The insurance company may try to contact you in the form of a phone call, a recorded conversation, or even a letter. The insurance company representative may tell you that they cannot pay you unless you fully cooperate. This may include not only answering questions, but also signing documents that allow them to access your medical records.
Before you speak to them or sign any documents, you should know the following information:
Tip #1: Remember, it’s a business
Insurance companies are in business to make money, just like any other business. One of the major ways they make money is to collect premiums from business. The less they have to pay out on claims, the more profit they make. Therefore, it’s in the insurance company’s financial interest to deny claims because it means more profit for them.
Tip #2: Watch what you say
Any information that you provide the insurance company can be used against you at a later date, including at a trial to determine what benefits you may be owed. If the telephone call is being recorded, be very careful of what you say. Don’t rush through your statement.
Tip #3: Be polite and professional
The insurance company representative who calls you may ultimately make the decision on whether or not to start your benefits, so don’t be combative and try to be courteous.
Tip #4: Consult an attorney before giving a statement
We are often asked if you have to provide a statement. The answer is no, you aren’t required by law to provide a statement. However, it may slow the process down. If you’ve been asked to give a statement to an insurance company, it’s best to contact a lawyer before this call takes place. If there is information that you don’t wish to disclose, you should talk about it with your attorney first. Here at Gerber & Holder, we are more than happy to discuss this situation with you.
Tip #5: Don’t sign a blanket medical release form
You also don’t have to sign a blanket medical release form. In Georgia, the insurance company is allowed to obtain medical records when you have filed a workers’ compensation claim. There is a form that is typically used called a WC-207, which allows the insurance company to obtain your medical records from specific providers. Make sure that when you sign the WC-2017 form that it signifies the specific medical provider they are requesting records from.
Tip #6: Stay on topic
When you talk to an insurance representative after the injury, make sure to limit the scope of what you discuss. Avoid getting into details that don’t concern your injury. Some examples would be problems with other employees, or disputes you may have with your bosses. This information may be used to deny your claim when, in reality, it has nothing to do with your injury. For example, the carrier may say that you weren’t actually injured on the job, that it was merely a retaliatory claim because you didn’t like your boss.
Tip #7: Be honest, but smart
Finally, be honest with the insurance agent about any prior injury, but only if asked. Don’t offer commentary on past incidents or accidents if not asked about it. Let’s be clear, you should always be truthful — but not necessarily forthcoming regarding information that hasn’t been asked about.
When to get help from an experienced Georgia
workers’ compensation lawyer
In conclusion, we find it most helpful and practical to speak with a knowledgeable attorney before communicating with any insurance company. In fact, after you hire an attorney, the insurance company cannot directly communicate with you. All communications must go through your attorney, who will help you present your case in the best light to the insurance company.
If you have any more questions about talking to the insurance company after an injury, don’t hesitate to contact the experienced attorneys at Gerber & Holder Law.