ou got hurt at work. You reported the injury. Now your phone is ringing and it is the insurance company.
They sound helpful. They may tell you they want to “get you taken care of.” Most injured workers assume this person is on their side.
They are not.
Who the Claims Adjuster Actually Works For
Here is something most injured workers do not think about: your employer pays for workers’ compensation insurance. Every month or every quarter, the company writes a check to the insurance carrier. It works like car insurance in most instances. If your employer has a lot of claims, their rates go up the next year.
So when the claims adjuster picks up your file, they have two jobs. First, they must investigate fairly and pay benefits that are legitimately owed. That is the law under California Code of Regulations section 10109. Second, they must protect the insurance company and the employer from paying for claims that are not valid or paying more than what is actually owed.
Those two duties pull in opposite directions. And in practice, the second one usually wins.
The adjuster is not a bad person. They are doing a job. But their job is to manage costs, close files, and keep the employer’s premiums from going up. Your recovery matters to them, but it is not their primary concern.
What the Law Says vs. What Actually Happens
Under Labor Code section 3202, workers’ compensation law is supposed to be “liberally construed” in favor of injured workers. That is the actual text of the statute. The system was built to provide benefits when they are owed.
Under Labor Code section 5402, the insurance company has 90 days from the date the employer learned about your injury to accept or deny your claim. If they do not deny within 90 days, your claim is presumed compensable. That is a powerful right most injured workers do not know they have.
In reality, many adjusters routinely deny claims and hope you go away. They delay treatment authorizations. They send temporary disability checks late. They make the process confusing enough that a significant number of injured workers simply give up.
The insurance company is betting that you do not know your rights. If you do not know you can challenge a denial, the denial stands. If you do not know your temporary disability payments are due every 14 days under Labor Code section 4650, you will not push back when they are late. If you do not know you have the right to a Qualified Medical Examiner, you will accept whatever the insurance company’s doctor says about your condition.
That is what they are counting on.
The Medical Records Trap
One of the first things the adjuster will do is ask for your medical history. Not just records from this injury. They want everything. Every doctor, every complaint, every MRI going back years.
Why? Because the more they know about your past injuries, the more ammunition they have to argue that your current problem is not work-related. If you had a back complaint five years ago and now you are claiming a back injury at work, the adjuster will use that old treatment to build a case against you.
This is where injured workers make their biggest mistake: they cooperate too much.
You are required to tell the adjuster what happened in this case. When did the injury occur? What were you doing? What body parts are affected?
You are not required to sign a blanket medical authorization giving the insurance company access to your entire medical history. You are not required to tell them about the car accident three years ago or the knee surgery in 2019. Every piece of prior medical information you hand over gives them material to deny or minimize your claim.
If they push for your full history, that is a red flag, not a conversation you need to continue.
They may be entitled to this information down the road, but often not right out the gate and this goes to a question of apportionment not causation of your current injury.
The Deny, Delay, Defend Playbook
Adjusters follow a predictable pattern. Understanding it helps you protect yourself.
Deny first, ask questions later. An adjuster may deny your claim based on a five minute exam at an industrial clinic. They may deny it because you reported late, or because the mechanism of injury does not match what they expected. Some denials are legitimate. Many are not.
Delay everything. Your MRI authorization sits on a desk. Your TD checks arrive late. Your calls go unreturned. None of this is accidental. The system rewards delay because delay saves money.
Defend with your own records. This is why they want your full medical history. They are not trying to understand your condition. They are building a file to use against you at a QME evaluation or at trial.
Knowing the pattern is half the battle. Here is how to protect yourself.
What to Do When the Workers’ Comp Adjuster Calls You
Tell them about this injury. Nothing else. Give the adjuster the basic facts: when it happened, what you were doing, what hurts. If they ask about prior injuries, you can say: “I am reporting a work injury that occurred on this date.” You do not owe them a medical autobiography.
Do not sign a blanket medical release. The adjuster may tell you the claim cannot move forward without it. That is not accurate. Your claim moves forward based on whether you were injured at work, not on whether you signed a release for every doctor you have seen since 2015.
Document everything. Write down every phone call: the date, the time, who you spoke with, what was said. Save every letter and email. If the adjuster tells you something over the phone, follow up with a text or email confirming it. Adjusters handle hundreds of files. They will not remember what they told you. But if you have it in writing, you have proof.
Know your right to a QME. If your claim is denied, you can request a panel of Qualified Medical Examiners. The QME is a neutral doctor who evaluates your condition and issues a report on causation, permanent impairment, and future medical needs. This is one of the most important stages in any California workers’ comp case, and it is where unrepresented workers lose the most ground.
Know the rules on temporary disability. If your doctor takes you off work, your TD payments are due every 14 days under Labor Code section 4650. Late payments can trigger a 10% increase. Willful delay can lead to a 25% penalty under Labor Code section 5814. Most injured workers assume late checks are just how the system works. They are not. There are rules, and there are consequences, but only if someone holds the adjuster accountable.
We Used to Sit on the Other Side of the Table
Before founding Lee Partners Law, David Lee and Michael Lee spent years as insurance defense attorneys. We worked with the adjusters, reviewed QME reports, and helped build the arguments that reduced or denied claims.
Now we use that experience for injured workers. When we review a file, we know what the adjuster is looking for, where their case is weakest, and which denials will not hold up. If an adjuster has contacted you and you are not sure what to say, what to sign, or what to do next, call or text us. The consultation is free and you will talk to an actual attorney.
We represent injured workers throughout Southern California, including Los Angeles, the Inland Empire, Orange County, Ventura County, the San Fernando Valley, the San Gabriel Valley, the High Desert, Riverside, and San Diego.
