Check Out Our Podcast: The Verdict
The first 90 days after a workplace injury can make or break your workers’ comp case, but most injured workers don’t realize that until it’s too late. In this episode of The Verdict, Clarke and lead worker’s comp attorney Brian Groesser explain what really happens in those first few weeks and why your attorney becomes your biggest advocate against the insurance adjuster.
Without proper guidance and representation, claims can get lost in the shuffle, leading to delays in medical treatment and compensation. The duo discusses real-life examples, illustrating how proactive legal representation can make a substantial difference in the outcome of a case. Brian lays out how an experienced attorney can put pressure on the insurance company, demand timely care, and keep your case from slipping through the cracks.
Here’s what we discuss in this episode:
📆 Why the first 90 days are the most important in your case
📉 How insurance adjusters quietly minimize your benefits
🤝 Who’s really on your side — and who isn’t
0:00 – Counteracting adjusters
3:13 – Importance of the first 90 days
Workers comp, attorneys, legal representation, insurance, insurance claims, workplace injury
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SPEAKERS
Clarke Speaks 00:00
I'm Clark, speaks the catastrophic injury lawyer. Welcome to the verdict. Hi. Welcome back to the verdict. We're here with Brian grocer. Brian grocer is the lead workers compensation attorney at speaks law firm, Brian. We're continuing our conversation about things that happen early in a work in a workers compensation case. We were talking before about the role of the insurance adjuster. And I remember making the comment, they're never gonna come and say, well, for this reason, you're gonna pay you more, right? And But in fairness, we're never gonna come at them and say, Hey, this is why we think you should pay our client less. So it's not necessarily. We're not saying that they're terrible people, and I think we've made that clear. But they have a job to do, and we have a job to do on our side. So how can we help counteract the things that they do, to try to minimize the value in the claim that how much is paid to a client, how much is paid to an injured person, how much is paid to
Brian Groesser 00:54
a worker? Well, it's the most important aspect of our job, right? Because I just, we just described in the last episode, what an adjuster's job is, is to adjust down right, to keep those expenses down. Well, there's pressure as a as a worker, that you know, that that's being pushed down on you, right, that they're trying to keep the expenses down, keep the costs down, and by, you know, making sure that your medical treatment goes a certain way and maybe doesn't get into the surgery realm, and maybe making sure that you're going back to work, even though you're not physically or mentally ready to go back to that job, but making sure that you go back so that you don't have to be an expense to the carrier. That's where we come in, right? We come in to make sure that your medical treatment is going the way that it needs to be. If you need to see an orthopedic that you are going to the right orthopedist to go get the treatment that you need if an MRI a lot of times, what happens is urgent care will recommend, and I know many of you listening that have been in the comp system have probably experienced this where physical therapy is recommended, and it's been a month and you still haven't gone to see a physical therapist. An MRI has been recommended. It's been two months and you still haven't received an MRI. Adjusters are typically adjusting 150 175 claims. They are inundated with claims, and so in all honesty, your claim can get lost in the shuffle. It happens when you have somebody that is advocating for you, like an attorney. It gets put back onto their radar, and pressure gets put on them to get that physical therapy appointment set, to get that MRI referral happening, to get you in to see the orthopedic and then to make sure that that treatment is going along and progressing in a proper way. Same thing is true with money. You have a claim, and they'll, you know, maybe not pay you an issue. I just took a phone call right before this podcast. I just took a phone call from a new client, and that that is exactly what was happening to them, that they got injured in February, and here we are at the end of March, and they still haven't received anything from the insurance carrier. They think it's a compensable case, but they haven't received any money, and they've got bills to pay. Well, guess who's going to be making that phone call today to the adjuster to say, Hey, where's my client's money? You know, she's been out of work for six weeks. Why hasn't she been paid much easier for the attorney to make that call than for the worker to make that call? Because the attorney has the ability to pursue legal action. We can do something. We can do something about it. Yeah, and also,
Clarke Speaks 03:13
we know what's reasonable and what's not correct, right? When they say, when they say, Hey, our policy is to do this. That's my favorite. Our policy is to wait this period. We can say, I understand your policy. The law requires this, and we are much more, in my experience, much more likely to be able to get a timely result that is favorable than if they were to do let me ask you this, if that person would have called you within a within a day or two of the accident, would they be in this situation? Now, do you think?
Brian Groesser 03:45
No, no, because we would have it monitored from day one, and as soon as that check, if you've been out of work for more than seven consecutive days and or seven days total, and you still haven't received a check, that would trigger for us being like, hey, you know, where's Jane Smith's check? You know, why hasn't she received anything? Have you accepted this claim? Have you denied this claim? What is your position on this claim? It puts pressure on the carrier to actually act initially, the first 90 days is filled with activity in a worker's compensation case. In fact, the first 90 days can make or break your case. I did when I did defense work, I talked to adjusters about how important the first 90 days are in a case, it's equally important to the workers in terms of getting things moving in the right direction in those first 90 days, and having an advocate on your side in those 90 days, if you're a worker, is vitally important, because You don't want to navigate those all important days without somebody guiding you along that way. And you don't want the guide to be someone from the other side, the adjuster is not your guide, right? The adjuster, like we've talked about, is working for the other team. That shouldn't be your guide through the workers comp system. That's
Clarke Speaks 04:58
like me asking if. I'm the GM for the Dallas Cowboys, and I ask the GM for the Philadelphia Eagles. Who should we draft first? Who should we take in this draft? A naive person might think this person is qualified, knows the system, and might be in a position to give me reasonable advice, but if I know more about it a little deeper, I'm going to say they're not going to give me the advice that I need to do the best that I can under these circumstances. Is that a fair analogy? Yeah,
Brian Groesser 05:27
because ultimately, they're not necessarily looking out for your best interest. They're human. They want you to get better. You got hurt. They're not evil. They're not like I hope this person suffers for the rest of their life. They want them to get better. But at the end of the day, they have a job to do, and their job is to keep the costs down, and so they are looking out for the insurance carrier's best interest, not your best interest, whereas your attorney is looking out for your best interest.
Clarke Speaks 05:52
Thank you, Brian. When we come back, we'll talk about people who might want to represent themselves during the first 90 days, and what that might mean to their case. We'll see you next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
SPEAKERS
Clarke Speaks 00:00
I'm Clark, speaks the catastrophic injury lawyer. Welcome to the verdict. Hi. Welcome back to the verdict. We're here with Brian grocer. Brian grocer is the lead workers compensation attorney at speaks law firm, Brian. We're continuing our conversation about things that happen early in a work in a workers compensation case. We were talking before about the role of the insurance adjuster. And I remember making the comment, they're never gonna come and say, well, for this reason, you're gonna pay you more, right? And But in fairness, we're never gonna come at them and say, Hey, this is why we think you should pay our client less. So it's not necessarily. We're not saying that they're terrible people, and I think we've made that clear. But they have a job to do, and we have a job to do on our side. So how can we help counteract the things that they do, to try to minimize the value in the claim that how much is paid to a client, how much is paid to an injured person, how much is paid to
Brian Groesser 00:54
a worker? Well, it's the most important aspect of our job, right? Because I just, we just described in the last episode, what an adjuster's job is, is to adjust down right, to keep those expenses down. Well, there's pressure as a as a worker, that you know, that that's being pushed down on you, right, that they're trying to keep the expenses down, keep the costs down, and by, you know, making sure that your medical treatment goes a certain way and maybe doesn't get into the surgery realm, and maybe making sure that you're going back to work, even though you're not physically or mentally ready to go back to that job, but making sure that you go back so that you don't have to be an expense to the carrier. That's where we come in, right? We come in to make sure that your medical treatment is going the way that it needs to be. If you need to see an orthopedic that you are going to the right orthopedist to go get the treatment that you need if an MRI a lot of times, what happens is urgent care will recommend, and I know many of you listening that have been in the comp system have probably experienced this where physical therapy is recommended, and it's been a month and you still haven't gone to see a physical therapist. An MRI has been recommended. It's been two months and you still haven't received an MRI. Adjusters are typically adjusting 150 175 claims. They are inundated with claims, and so in all honesty, your claim can get lost in the shuffle. It happens when you have somebody that is advocating for you, like an attorney. It gets put back onto their radar, and pressure gets put on them to get that physical therapy appointment set, to get that MRI referral happening, to get you in to see the orthopedic and then to make sure that that treatment is going along and progressing in a proper way. Same thing is true with money. You have a claim, and they'll, you know, maybe not pay you an issue. I just took a phone call right before this podcast. I just took a phone call from a new client, and that that is exactly what was happening to them, that they got injured in February, and here we are at the end of March, and they still haven't received anything from the insurance carrier. They think it's a compensable case, but they haven't received any money, and they've got bills to pay. Well, guess who's going to be making that phone call today to the adjuster to say, Hey, where's my client's money? You know, she's been out of work for six weeks. Why hasn't she been paid much easier for the attorney to make that call than for the worker to make that call? Because the attorney has the ability to pursue legal action. We can do something. We can do something about it. Yeah, and also,
Clarke Speaks 03:13
we know what's reasonable and what's not correct, right? When they say, when they say, Hey, our policy is to do this. That's my favorite. Our policy is to wait this period. We can say, I understand your policy. The law requires this, and we are much more, in my experience, much more likely to be able to get a timely result that is favorable than if they were to do let me ask you this, if that person would have called you within a within a day or two of the accident, would they be in this situation? Now, do you think?
Brian Groesser 03:45
No, no, because we would have it monitored from day one, and as soon as that check, if you've been out of work for more than seven consecutive days and or seven days total, and you still haven't received a check, that would trigger for us being like, hey, you know, where's Jane Smith's check? You know, why hasn't she received anything? Have you accepted this claim? Have you denied this claim? What is your position on this claim? It puts pressure on the carrier to actually act initially, the first 90 days is filled with activity in a worker's compensation case. In fact, the first 90 days can make or break your case. I did when I did defense work, I talked to adjusters about how important the first 90 days are in a case, it's equally important to the workers in terms of getting things moving in the right direction in those first 90 days, and having an advocate on your side in those 90 days, if you're a worker, is vitally important, because You don't want to navigate those all important days without somebody guiding you along that way. And you don't want the guide to be someone from the other side, the adjuster is not your guide, right? The adjuster, like we've talked about, is working for the other team. That shouldn't be your guide through the workers comp system. That's
Clarke Speaks 04:58
like me asking if. I'm the GM for the Dallas Cowboys, and I ask the GM for the Philadelphia Eagles. Who should we draft first? Who should we take in this draft? A naive person might think this person is qualified, knows the system, and might be in a position to give me reasonable advice, but if I know more about it a little deeper, I'm going to say they're not going to give me the advice that I need to do the best that I can under these circumstances. Is that a fair analogy? Yeah,
Brian Groesser 05:27
because ultimately, they're not necessarily looking out for your best interest. They're human. They want you to get better. You got hurt. They're not evil. They're not like I hope this person suffers for the rest of their life. They want them to get better. But at the end of the day, they have a job to do, and their job is to keep the costs down, and so they are looking out for the insurance carrier's best interest, not your best interest, whereas your attorney is looking out for your best interest.
Clarke Speaks 05:52
Thank you, Brian. When we come back, we'll talk about people who might want to represent themselves during the first 90 days, and what that might mean to their case. We'll see you next time. Thanks for joining us. Don't forget to subscribe and follow us to stay up to date with our weekly episodes. We'll see you next time you.
