"I can't get my adjuster to call me back!"
Over the last few years, I have spoken with hundreds of injured employees throughout Texas, and especially in Abilene, Texas, where I practice workers' compensation law. One of the most common complaints that I get is this one. They got injured on the job. They finally got their claim going. Then, when they need more information about their claim, their adjuster won't give them anything.
Now, before I go any further, I want to make it clear that there are some workers' compensation adjusters out there who do a good job. They stay on top of their case load. They answer questions in a timely way. They have to sometimes be firm, but they never avoid a claimant's questions. I wish that there were more like this. But the truth of the matter is that some adjusters get in the habit of ignoring incoming communications from claimants either because their case load is too high, and they just don't have time to talk to everyone or because they are hoping that the claimant will eventually go away and drop their claim, making their job easier.
Getting an adjuster to respond to your communications without an attorney representing you can sometimes be tricky, but here are a few pointers.
Keep a Journal. The first step toward getting an adjuster to call you back is to document everything. Find an old notebook that is lying around your house and label it "Claim Journal." Then, every time you send a fax or an email, and every time you call the adjuster, make a note in the journal about the communication. If you talked to the adjuster, be sure to summarize everything that was said. Make sure you are documenting everything that is said and done, even missed calls. You may need this later.
Be Ready. Make notes about all of the issues you want to discuss with your adjuster in your journal so you can get right to the point if they call you back.
Answer Your Phone/Set Up Your Voicemail. Speaking of missed calls, be sure you are answering your phone whenever you can, even if you have to tell your adjuster you'll need to call them back later. Also, make sure your voicemail is working, so that they can leave you a message if you aren't available (or if your mobile phone is turned off). If you don't do this, then their file is going to be peppered with notes that talk about how they can't get you on the phone when they try to return your calls.
Spell Out Your Efforts to Contact Them in Detail. Now that you've created your journal and made sure that you are ready to respond, you have the ability to get their attention. How? By pointing out - in writing - all the ways you have tried to contact them. Once you have reached out to your adjuster two or three times without getting a response, prepare a written document that sets out your questions for the adjuster and describes - in specific detail - the communications you have directed at them. If you have their email, that will work, but if you don't have their email, then prepare a written fax. In the document, you'll need to say something like this:
"I attempted to call you at 1:03 pm on September 3 to discuss an unpaid expense reimbursement, and was sent to your voicemail where I left a detailed message. I didn't hear back from you for the next week. I then called again on September 10 at 10:33 am and was again sent to a voicemail. You never returned my call. I called again twice on September 12 (at 9:00 am and 3:15 pm), and received no response. It has now been twelve days since my original call. Would you please tell me when you will be available so we can discuss this issue? If I have not heard from you within the next three days, I will assume that you intend to continue to ignore my calls and I will file a complaint with the Texas Department of Insurance."
In most cases, this type of well-documented communication will get their attention. Why? Because this type of documentation has to go in their file, and the adjuster knows that they can get in trouble with their supervisor and/or the Texas Department of Insurance if they don't respond properly to your communications. It demonstrates to their superiors that they have dropped the ball.
File a Complaint. If your adjuster continues to ignore your calls for more than ten days to two weeks, you should file a complaint with the Texas Department of Insurance. You can find more information about how to file a complaint here.
Hire a Lawyer. The sad truth of the matter is that, in some situations, you are going to find it impossible to make progress on your claim because your adjuster won't take action. In those situations, your only recourse may be to hire a qualified workers' compensation lawyer who will know how to resolve the issue.
Again, the experience I am describing above is not always the one to expect. In some cases, adjusters and injured workers are able to communicate in ways that keep the claim moving forward in a smooth fashion. However, if you have an adjuster who won't talk to you, you can't afford to just drop your case and give up. You need to take action.