Category: Workers’ Comp Insurance Adjusters


The workers’ compensation adjuster just sent me a check for a disability rating. Does this mean my case is settled?

If you are paid a workers’ comp check for a disability rating, it does not mean your case is settled. When you receive workers’ compensation benefits in Georgia and/or you are being treated by a workers’ compensation doctor after a workplace injury, eventually you may reach maximum medical improvement (MMI). Once you reach MMI, your  … Read more

Sedgwick Claims Management fined over $1M for its utilization review practices in CA

Not long ago, we wrote about how Sedgwick CMS’s unreasonable delays in delivering treatment to an injured worker killed him.  Well, they’ve recently agreed to a $1,129,600 settlement in response to the allegations brought by the California Workers’ Compensation Appeals Board for labor code violations stemming from Sedgwick’s utilization review practices. What is utilization review,  … Read more

How a Workers’ Compensation Adjuster’s Intentional Delays Killed a Man

How many times could a company with a homegrown, wholesome name like Ralph’s Grocery Co. turn a blind eye to the medical needs of an injured employee? According to the California Workers’ Compensation Appeals board, 11 is the lucky number. The trouble began in December 2003, when Charles Romano sustained an injury to his left  … Read more

When Dealing with Claims Adjusters, Always Read the Fine Print

Here is the story of one man, his company, and a rather unscrupulous claims adjuster. Kevin Miles, the sole owner and manager of Nebo Ventures, LLC, made his living helping various companies obtain and fulfill contracts with both state and local governments. In 2003, he was contracted by a larger company (formerly known as NovaPro,  … Read more

Ohio employers win $860 million after overcharged by workers’ compensation insurer

A Cuyahoga County judge has awarded nearly $860 million in restitution to a group of Ohio employers involved in a class-action lawsuit that began in 2007. The suit claimed that the Ohio Bureau of Worker’s Compensation, which provides worker’s compensation benefits to about two-thirds of Ohio’s workforce, overcharged the more than 270,000 employers for worker’s compensation  … Read more

Run away when the workers’ comp adjuster offers $7,000 immediately after your husband has died

I have a client whose de facto husband–with whom she had two sons–died in a roofing accident.  Under the Georgia Workers’ Compensation Act, the sons can receive the workers’ compensation benefits at the weekly rate to which he would be entitled had he lived (2/3 his average weekly wage up to the $525 per week  … Read more

Can workers’ comp claims investigators use my Facebook feed as evidence?

In the midst of a workers’ comp case, most insurance companies will use whatever they can get their hands on to protect their assets—including social media. Although a legal precedent has not been set, some courts have allowed the use of photos and personal information posted to social media sites as evidence for a plaintiff’s condition, or  … Read more

Atlanta Workers’ Comp Lesson Number 1: Check Your Mail

Ready Mix USA can testify that one of the quickest ways to lose a workers’ comp case is to ignore a notice sent by the Georgia Courts. After failing to show for a worker’s compensation hearing for one of their employees, Terrell B. Ross, both Ready Mix and their insurance company, Liberty Mutual, found themselves  … Read more

Temporary Workers Face Higher Risk of Workplace Injuries

Olga Pierce, Jeff Larson, and Michael Grabell of ProPublica, a non-profit organization that provides high-quality, investigative journalism, brought some disturbing facts about temporary work to light in an article titled “Temporary Work, Lasting Harm.” According to ProPublica’s analysis of workers’ compensation claims across the United States, temp workers in high-risk states like California and Florida  … Read more