Insurance adjusters believe they are reasonable people just doing their jobs. I am sure that in many cases, this is true. However, you must remember that their entire job is to put up with people (individuals, state regulators, healthcare providers, and attorneys) all day long who are asking them for money. Too many of them quickly pick up the habit of seeing every injured person as a lazy, shiftless enemy. They will use every opportunity to deny or delay benefits, distort your words, and discourage you from seeking additional treatment or benefits. This is what they get paid to do.
This is why it is often necessary to employ the services of an attorney. Many injured employees make this decision, although it is not required by any law. Workers' compensation in Texas runs through a labyrinth of rules, deadlines, forms, and hearings. You must make it more hassle to pay you the benefits or provide you the necessary medical care than the adjuster is willing to endure. That takes time, know-how, and patience. An attorney can work with you and your doctor to provide evidence to the adjuster that will sway things in your favor and avoid a hearing, or proceed to a hearing to obtain either an agreement or an order to pay benefits when the adjuster is unwilling to do so without escalating the case further. For those that choose not to employ an attorney, the insurance adjuster must communicate directly with the employee or another individual (such as a spouse) who you designate to receive confidential information on your behalf, and/or the employee may seek assistance of a non-attorney "ombudsman" through the OIEC who can provide free assistance to an employee, but cannot act as attorney or represent the employee.
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