What Does a Workers Compensation Claims Adjuster Do in North Carolina? 2024

Dealing with a workplace injury can be demoralizing and infuriating, especially if you have already filed a workers’ compensation claim and it has been denied. You may be feeling frustrated at your employer, confused about the whole process, and pained by your injury, which may or may not be devastating, depending on your situation.

While you focus on your recovery, a claims adjuster is likely investigating your case. You may be wondering: What does a workers’ compensation claims adjuster do in North Carolina?

What Do Workers’ Compensation Claims Adjusters Do in North Carolina?

The primary job of a workers’ compensation claims adjuster is to investigate and evaluate your workers’ comp claim to determine if the insurance company should pay out and how much. Injured workers in North Carolina can receive benefits regardless of who caused the accident. Even though North Carolina is a no-fault state when it comes to workers’ comp, a claims adjuster still has to investigate your claim to be certain the incident actually happened.

A workplace injury can be anything from a brief inconvenience to a catastrophic situation that results in life-changing injuries. It depends largely on the nature of the accident and how badly you were injured because of it. North Carolina’s comprehensive Workers’ Compensation Act details all of the significant and relevant rights that North Carolina workers have in the wake of a workplace injury.

North Carolina requires every business that employs at least three people to carry workers’ comp insurance of some kind in the unfortunate event that an employee gets hurt and needs time off to recover. When a claims adjuster evaluates the situation, they may find some irregularity that could halt your benefits.

The Insurance Claims Adjuster’s Process

The insurance claims adjuster’s main goal is to assess the nature of the workplace accident and determine if the company’s insurance carrier should pay the injured worker any workers’ comp. The adjuster decides this by launching an independent investigation into the accident and making their decision based on the evidence they find. Here is a look into their usual process:

• Investigation: First and foremost, the claims adjuster will try to contact the injured employee to hear their version of events. They will want to know the timeline of the accident, how it happened, who witnessed it, how they were injured, and the medical treatment they received. They may also contact the worker’s supervisor and doctor for more information.
• Evaluation: After gathering all their evidence for the accident, the claims adjuster will evaluate it to paint a clear picture of the accident as the evidence suggests it happened. From there, they may decide if the workers’ comp claim is valid or fraudulent. If they determine the accident is genuine, they will decide an appropriate amount of workers’ comp that the worker deserves to be paid.
• Settlement: The insurance claims adjuster will negotiate with the injured employee to agree on a settlement. It is likely a good idea for the employee to have a workers’ comp lawyer present during these discussions. If you do not think the adjuster’s settlement offer is sufficient, you don’t have to accept it. Your lawyer can help you negotiate a better settlement offer if you have grounds to do so.
• Acceptance: Once you and the adjuster have reached an agreement, the adjuster may accept the offer and decide if the claim is ultimately accepted or denied.

FAQs

Q: What Can I Expect from a Claims Adjuster?

A: When you first interact with a claims adjuster, it may feel like an interrogation. Don’t worry. They are only there to get to the bottom of what happened. Answer any questions about the incident honestly, even if you are the one who caused the accident. The adjuster may also speak with your supervisor, your coworkers, and even your doctor to get a complete picture of the accident.

Q: Should I Have a Lawyer Present When I Meet with the Claims Adjuster?

A: Yes, it is recommended that you have a lawyer present when you meet with the claims adjuster. The adjuster works for your company’s insurance provider, and they may be inclined to authorize a minimal payment or no payment at all. Having legal representation present can take some of the burden of negotiating off your shoulders.

Q: What Is the Difference Between a Claims Adjuster and an Insurance Adjuster?

A: There is no difference between a claims adjuster and an insurance adjuster. This job may be referred to with different titles. Both titles describe someone whose job is to investigate insurance claims and determine if they are fraudulent or worth pursuing further action. Ultimately, the adjuster is the one who decides whether the insurance provider should pay you and how much.

Q: How Much Does a Claims Adjuster Make in North Carolina?

A: There is no telling how much a claims adjuster makes in North Carolina. However, it is important to know that an injured person does not have to pay an insurance adjuster for their services. Adjusters may work long hours, handle difficult clients, manage multiple claims at a time, and be required to tell injured people that their claims have been denied. Cooperating with your claims adjuster can make the process run smoothly and efficiently.

Reach Out to an Experienced Workers’ Comp Lawyer Today

Having to speak with an insurance claims adjuster can be a difficult experience, especially if you are trying to defend yourself and your accident claim. The guidance of an experienced workers’ comp lawyer during your discussion can make all the difference. It can be beneficial to have someone on your side who knows how to help you and can take control of your case.

The legal team at Bridgman Gantt Law Offices understands how difficult it can be to deal with a claims adjuster. We can provide you with comprehensive legal assistance, manage your case, gather additional evidence, and protect your interests from predatory insurance companies. Contact us to speak with a valued team member about your case.