The Role of the Adjuster in a Texas Non-Subscriber Case

Suffering a work-related injury can be physically, emotionally, and financially devastating. When an employee gets injured on the job, they often rely on workers’ compensation benefits to cover medical expenses and lost wages. However, Texas law does not require employers to have workers’ compensation coverage. Employers who opt out of the workers’ compensation program are considered “non-subscribers” and may offer an alternative benefits plan or no coverage.

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If you have been injured on the job in Texas and your employer is a non-subscriber, you may be considering pursuing a claim through your employer’s alternative insurance or pursuing a personal injury lawsuit. You may also be wondering what the role of the insurance adjuster is in this process.

In a non-subscriber work injury claim, insurance adjusters play a crucial role in determining the outcome of your claim. Here, we will explore how adjusters can impact non-subscriber work injury cases and the obstacles they might put up for employees trying to obtain benefits or compensation.

What Is a Non-Subscriber?

In Texas, a non-subscriber is an employer who has opted out of workers’ compensation coverage. According to the Texas Department of Insurance (TDI), 25% of Texas private-sector employers were non-subscribers in 2022.

You cannot file a workers’ compensation claim for a work-related injury if your employer is a non-subscriber.

What Are Your Options for a Non-Subscriber Claim?

You still have options for receiving compensation for your injuries if your employer is a non-subscriber. Some non-subscribers offer alternative occupational benefit plans that may cover medical and wage benefits to injured employees. And if your employer’s negligence caused or contributed to your injury, you may sue your employer for personal injury damages. Your first step in a personal injury claim is typically to make a demand to your employer’s liability insurer.

What Is the Role of the Insurance Adjuster?

After you suffer a work-related injury, your non-subscriber employer will typically refer you to the work injury insurance adjuster. Adjusters in a non-subscriber work injury claim are responsible for assessing the validity and extent of the claim. Their primary duty is to investigate the incident, review medical records, and negotiate settlements on behalf of the insurance company. While the purpose of insurance adjusters should be to facilitate a fair resolution, their actions can significantly influence the outcome of the claim.

What Are Some Common Obstacles?

While talking to an insurance adjuster is often portrayed by your employer as a necessary step to receive compensation, it also determines if the insurance company needs to pay any compensation at all. Some common obstacles presented by insurance adjusters include:

Delayed claim processing. Insurance adjusters may intentionally prolong the claims process, causing financial strain on the injured employee who cannot work during this time.

Disputing injury severity. Adjusters often contest the severity of the injury or may argue that it is not the employer’s responsibility. This dispute can lead to a reduced settlement offer or a complete denial of the claim.

Lowball settlement offers. Insurance adjusters may make low settlement offers to resolve the claim quickly and save the insurance company money. Employees who are unaware of their rights and the true value of their claim may accept these offers out of desperation.

Medical evaluation manipulation. Insurance adjusters may require injured employees to undergo medical evaluations by doctors of their choice, who may be biased toward the insurance company. These evaluations can downplay the severity of injuries or attribute them to pre-existing conditions.

Due to these obstacles, it is essential to consult with a work injury attorney before you talk to an insurance adjuster or accept a settlement for your non-subscriber claim.

Make Sure You Are Protected by an Attorney

Insurance adjusters play a pivotal role in non-subscriber work injury claims, and their actions can significantly impact your ability to obtain benefits. It is crucial to seek counsel from an experienced work injury attorney who can protect your rights, negotiate with insurance adjusters on your behalf, and advocate for fair compensation.

Here at Armstrong Lee & Baker, our experienced work injury attorneys are here to hold your employer accountable. We have won millions of dollars for our clients and are not afraid to go to trial to fight for your rights. Call us today for a free consultation.

Scott Armstrong

Scott Armstrong is the Managing Partner and co-founder of Armstrong Lee & Baker LLP. Known for his strategic insight and relentless pursuit of justice, Scott personally guides the firm’s approach to complex cases, including catastrophic injuries, vehicle accidents, workplace injuries, and product liability. His leadership has created a culture where excellence, innovation, and dedication to client success are paramount, and his influence is evident in every case the firm handles, often resulting in hundreds of millions recovered for clients.