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Why Has My Adjuster Stopped Responding?

In Florida, there is no liability to an insurance company for failing to respond to an injured workers requests for medical treatment, authorization of diagnostic testing, or untimely payment of lost wage benefits. In fact, the only liability to an insurance company or adjuster for failing/refusing to respond to an injured workers requests are attorney’s fees if the injured worker is represented.

According to Florida statute 440.34, if the insurance company fails to timely respond to a request made by the filing of a petition for benefits (through the efforts of an attorney), the insurance company is responsible for attorney’s fees and costs to that attorney. As such, a Florida workers compensation attorney will have far greater success in getting benefits timely provided to injured workers versus the injured worker attempting to obtain such benefits on his or her own. 

Intentional Non-Response

In light of the above, insurance companies will sometimes intentionally fail to respond to requests not only by the injured worker for medical treatment or lost wages but also by the medical provider. The reason they do this is that they are intentionally trying to discourage the injured worker from continuing to pursue workers compensation benefits. Many times, injured workers have health insurance coverage. By failing to timely respond to medical treatment either at the request of the injured worker or the medical facility itself, the insurance carriers know that many times the injured worker will merely put such care and treatment through health insurance on the hope that medical treatment will be provided on a more timely basis.

Legal Loopholes and Delays

Unfortunately, that creates a very difficult situation for the injured worker as the injured worker, by placing medical treatment outside of workers compensation, will unintentionally allow the statute of limitations to run on their case (2 years from the date of accident or 1 year from the date of last medical treatment). Additionally, if the health insurance carrier finds out that the medical treatment that it is providing is due to a work-related incident, they may not only deny future care and treatment but also potentially seek reimbursement from the injured worker directly. 

The Importance of Using Workers’ Compensation

It is imperative that workers compensation injuries be handled by Worker’s Compensation doctors and at the expense of the Worker’s Compensation insurance Company. If you find that your insurance adjuster is no longer responding to your requests, in almost all instance, that is intentional. If this occurs, you need to immediately seek legal assistance so that a petition for benefits can be filed, thereby putting the insurance company on the clock to provide the requested benefits. Only the filing of such petition will require the insurance company to timely respond to medical requests, request for diagnostic treatment, and timely provision of lost wage benefits. 

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