Workers’ compensation adjuster giving you trouble? We covered this article to show you what to do.
When you file for workers’ compensation benefits in Kentucky, your case file goes to a workers’ compensation claims adjuster employed by your employer’s insurance carrier. Their duties include determining the quality of individual claims and initiating and controlling the delivery of medical and other benefits to the claimant. Unfortunately, workers’ compensation adjuster problems are not uncommon. However, there are ways to resolve these issues. Our experienced Kentucky workers’ compensation lawyers can explain how an attorney can help.
The Formal Complaint Process
If you have an issue with a workers’ compensation claims adjuster, you may be entitled to assistance from the state. The Kentucky Department of Insurance Division of Consumer Protection helps consumers with issues related to the insurance industry. If you’re unable to resolve an issue to your satisfaction by contacting the adjuster or their superiors, you have a right to ask the Commonwealth of Kentucky to intervene.
The Kentucky Department of Insurance has the authority to investigate and take any appropriate action to resolve a consumer complaint. The majority of cases are completed within 30 days.
However, the KDI’s formal complaint process may not resolve every issue you have with a workers’ comp insurance adjuster. There is no formal process to allow you to follow up if you are not satisfied. At this point, especially if a significant workers’ compensation benefit is on the line, you might want to consult a workers’ compensation attorney for help with your claim.
The Kentucky workers’ compensation lawyers of Morgan, Collins, Yeast & Salyer can help you resolve issues with workers’ comp insurance carriers, the KY Education and Labor Cabinet’s Department of Workers’ Claims, or your employer to ensure you are paid the benefits you deserve. Our law firm has recovered over $300 million in workers’ compensation benefits for hardworking Kentucky residents like you. Contact us today to set up your free consultation.
Common Examples of Frustrations with Workers’ Comp Adjusters
Workers’ compensation pays for medical bills and a portion of lost wages when an eligible employee suffers an occupational injury or illness and cannot return to work.
Not getting the appropriate workers’ comp benefits on time can cause unnecessary stress for an individual already struggling with an injury or medical issue and the potential loss of their livelihood. Unfortunately, Kentucky’s Workers’ Compensation Adjuster License Exam doesn’t cover client relations.
Typical complaints about insurance company workers’ compensation claims adjusters tend to be about:
- Claims denied without valid explanations
- Inadequate benefit amounts
- Excessive delays without reason
- Demands for additional information but no help obtaining it
- Poor communication and/or rude or dismissive behavior
- Being pressured into a settlement
- Misrepresentation of your medical condition or rights
- Required to speak to a different adjuster every time you call
Another State Option if a Department of Insurance Complaint Falls Short
The Kentucky Department of Insurance’s Consumer Complaint Form asks for identifying information about you and the insurer and provides space for “a detailed summary of your complaint.” It also asks whether you are represented by an attorney.
After filing a complaint with the Kentucky Department of Insurance, you should receive prompt written notice that your complaint has been received. The Kentucky Department of Insurance also forwards the notice to the workers’ compensation carrier and gives them 15 calendar days to respond — a deadline that “is strictly enforced.” The staff member assigned to your workers’ compensation case may contact you if they have additional questions.
This is a relatively straightforward program. This process may be all you need to correct a problem workers’ comp claim or adjuster and get the help you need.
If not, you also have the right to seek help from the Workers’ Compensation Specialist program within the KY Education and Labor Cabinet. This program is meant to resolve disputes regarding entitlement to benefits and expedite delivery of services to injured workers.
Specialists, formerly known as “ombudsmen,” are knowledgeable about Kentucky’s workers’ compensation program and applicable procedures. They are employed to:
Serve as a neutral and reliable information source for employees, employers, medical providers, and other workers’ compensation program participants - Respond to inquiries and complaints about the system and participants in the program
- Advise all parties of their rights and obligations under Kentucky Workers’ Compensation Law Kentucky workers compensation law
- Mediate disputes
- Help workers obtain medical reports and other documents necessary for a claim for benefits and help them complete claim forms
- Facilitate evaluation of injured workers to ascertain the feasibility of vocational rehabilitation (which workers’ comp pays for)
You can contact the office from 8 a.m. to 4:30 p.m. on weekdays at 800-554-8601 or kywcombuds@ky.gov
Consulting a KY Workers’ Compensation Lawyer
If your workers’ comp claim in Kentucky was denied and you feel like the insurance company and state functionaries are not truly listening to how your workers’ compensation needs are going unmet, contact the Kentucky law firm of Morgan, Collins, Yeast & Salyer. Our workers’ compensation attorneys will work on your case like you’re a member of our family. We also practice Social Security Disability law, so if your injuries qualify, we’ll also help you recover SSDI benefits.
Our workers’ compensation and Social Security Disability lawyers work for you on a contingency basis. This means our fee will be a percentage of what we recover for you. This protects you while incentivizing us to recover as much money as possible for you. You pay nothing upfront and nothing at all if we do not recover money for you.
We believe that every Kentuckian deserves a strong legal advocate who truly cares about them and their situation. We’ll focus on your workers’ comp claim so you can focus on getting better. Contact us today for a free consultation about how we can help you. We have offices located across Kentucky in Lexington, Somerset, Manchester, North & South London, Hazard, Paducah, Paintsville, Prestonsburg, and Princeton.
