When you sustain an injury on the job it’s crucial to report your injury to a manager or supervisor right away. You should also file a Form 18 with the Industrial Commission, which can be submitted electronically. Click here for Form 18.
In order for your case to be accepted, the insurance company must follow an investigative process to determine if your case will be accepted or denied. They will review medical records regarding the injury and talk to your employer. They will also talk to you by phone to obtain what is known in the workers’ comp industry as a “recorded statement.”
The recorded statement is a key phone call for them – and for you. What you say can lead to acceptance of your claim or denial.
Be careful how you explain what happened to cause your injury. And be careful how you answer seemingly harmless questions. You want to tell the truth, of course, but we have seen instances where the insurance adjuster spun the truth out of context in their efforts to deny claims.
What is a recorded statement?
The first contact you have with the workers’ comp insurance adjuster will likely be in the form of a recorded statement. The adjuster will call you and ask your permission to ask you questions over the phone while they record the conversation.
The recorded statement should be approached with great caution, and it is prudent to consult with an attorney prior to providing one. Here’s why.
The insurance adjuster is NOT on your side.
The primary purpose of the questions the adjuster asks during the recorded statement is to gather facts and information about your workplace accident. The adjuster might try and use this information to deny your claim.
That is why it is so important to be careful what you say and how you say it – and why we urge people to contact a workers’ comp lawyer before anything is said in that recorded statement.
“Anything unusual happen?”
Let’s say, for example, after you describe your work accident the adjuster asks you if anything unusual happened. Were you doing a task that is part of your regular job and were you doing it the way you normally would? The purpose of this question is not to judge whether or not you are a conscientious and careful employee. The answer you give might be directly related to the compensability of your case. In order for an injury to be considered compensable, there must be an “injury by accident,” which means that something out of the ordinary or unusual must have happened.
“Unusual” to the insurance company might mean that one particular shelf you were stocking had been moved higher than usual and you lost your balance and fell while reaching. To you, reaching for a high shelf is all in a hard day’s work. So you might reply that nothing unusual happened. Unusual to you might mean the electricity went out and you were stocking shelves in the dark.
If you tell them you were doing your job as usual at the time of injury and omit to report any unusual circumstances, such as the shelf having been moved a bit higher than normal, your case may potentially be denied.
To the insurance company, this critical piece of information could be a key factor in accepting or denying your claim. Adjusters know you are not aware of this. But they know we are!
There are a few exceptions to the “injury by accident” requirement. Different rules apply for injuries to the neck and back, hernias, and repetitious motion injuries such as carpal tunnel syndrome.
The most important thing that you have at the beginning of a recorded statement is your good word, and you need to make sure the adjuster is not distorting your word. Be honest, brief, stick to the facts, and don’t editorialize, i.e., “I didn’t get much sleep last night, and was feeling more tired than usual.” Be aware, we’ve seen some adjusters try to veer off-track and make judgments about the incident, i.e. “Were you taking anything like cold medicine?”
Why consult with an experienced workers’ comp attorney?
This is just one example of the hundreds of nuances of workers’ compensation law. That is why we urge anyone who is faced with giving a statement to an insurance representative to consult with a workers’ compensation attorney first. We can try to help you understand the types of questions you may be asked and possible pitfalls and nuances in language to heed. We can also be part of the conversation during your recorded statement. If inappropriate questions are asked we can object.
Get a FREE Evaluation From a NC Workers’ Compensation Lawyer
Not only do we have many experienced workers’ comp attorneys who deal with these issues every day, we have seven North Carolina Board Certified specialists in workers’ comp law. Many of our staff used to work for the insurance companies – and two worked at the NC Industrial Commission. There’s something to be said for that kind of inside experience.
PS: For the record, you have the right to decline a recorded statement and provide a written statement instead.