The Adjuster
The adjuster is the insurance carrier's employee assigned to your claim. This page explains what adjusters decide, how to deal with them in writing, whether you can change adjusters, and why your file keeps changing hands.
The person assigned to your claim
If you have ever been through a car insurance claim, you have already met this role. An adjuster is the person the insurance company assigns to manage a claim day to day. In Texas workers' comp, the adjuster works for the insurance carrier, the company paying benefits on your claim, or for a third-party administrator handling claims on the carrier's behalf. Adjusters are licensed by the Texas Department of Insurance and must follow claim-handling standards set by state rule.
The adjuster's decisions reach almost every part of your claim. The adjuster accepts or disputes the claim, starts and stops your income benefit checks, calculates your payment amount from your wage records, decides whether to request exams of you, refers treatment questions to reviewing doctors, and answers, or fails to answer, your questions.
Hold on to one fact from the start: the adjuster works for the carrier. The adjuster is not neutral, is not the state, and is not your caseworker. That does not make every adjuster your enemy. Many handle claims correctly. It means the adjuster's job is to manage the carrier's cost of your claim, and you should read every decision with that in mind.
Deal with the adjuster in writing
Phone calls with an adjuster leave no record. Written questions do, and by rule the carrier must respond to a claimant's communication within a set number of working days. Ask your questions in writing, keep copies, and when an adjuster promises something on the phone, follow up with a short message restating the promise. What to Ask the Adjuster About Your Claim lists the specific questions that get useful answers.
One of those questions is worth knowing by name. Carriers place recurring benefit checks on an automatic payment schedule, called schedule pay. Claims fall off that schedule, and when they do, checks stop without any decision behind them. The question "Please confirm my claim is on schedule pay" often finds the problem faster than any argument. If your checks have already stopped, When Your Comp Checks Stop Coming walks through the steps that get them found and paid.
Be careful when the adjuster asks for a recorded interview about your injury. That conversation has consequences the adjuster will not explain. Giving a Recorded Statement to the Adjuster covers it before you say yes.
Can I change workers' comp adjusters?
Not usually. The adjuster is the carrier's employee, and the carrier alone decides who handles its files. There is no form for requesting a new adjuster, and the Division of Workers' Compensation (DWC, the state agency that oversees comp claims) does not reassign carrier staff.
What you can do is create pressure through the proper channels. First, put your complaint in writing to the adjuster's supervisor; carriers reshuffle files internally more readily than they admit. Second, if the adjuster is violating claim-handling rules, such as failing to respond or failing to pay benefits that are due, file a complaint with DWC using DWC154. Discipline against an individual adjuster is rare, but complaints build a paper record, and in claims our office has handled, repeated complaints changed carrier behavior and in one instance produced an enforceable payment order. How to File a Complaint in Texas Workers' Comp explains the process. Third, understand that when a worker hires an attorney, the practical relationship changes, because the adjuster's decisions start receiving professional scrutiny.
Why do I keep getting handed to different adjusters?
Because adjusters change jobs often, carriers reassign files without notice, and no rule requires anyone to tell you. In one claim our office handled, the file passed through more than three adjusters; supervisors changed at least twice without announcement; and at one point the only way to learn who currently held the file was to call the carrier's main phone line and ask.
Each handoff carries risk, because knowledge about your claim leaves with the departing adjuster. In that same claim, a deduction from the worker's checks could not be explained afterward, because the adjuster who set it up was gone and the reasons were never written into the file.
Three habits protect you. Keep every question and answer in writing, so the file holds your claim's history even when the people change. When checks or answers stop, confirm first who the current adjuster and supervisor are, in writing, before assuming anything worse. And put your claim number on everything you send, so nothing depends on one person recognizing your name.
If you hire a lawyer, your direct line closes
Once you are represented, the carrier communicates with your attorney, and the adjuster will generally no longer discuss the claim with you directly. Workers sometimes experience this as being cut off. It is normal, and it is protective: it means nothing you say in a stray phone call can be used to undercut your claim.
