For the most part an adjuster works from day to day. They work in an office or cubicle, and go about their business. Recent polls and studies have shown that the adjuster is mostly satisfied with their job. They feel as if they make a difference, and that their job matters in the global sense.
However I think if I were to pull a series of claims professionals aside and ask them if they are really satisfied, I think the results would be different. The key question to ask would be “How could you do a better job, and become more involved and more proactive in the claim versus the environment you currently have?”
No carrier is perfect. When you are dealing with large sums of money and other monetary authority, there are a lot of people that are going to be involved. These people may or may not have influence on the claim as a whole, but the fact remains that their voice is going to be heard by the adjuster. That being said, given the claims environment most adjusters are in, how do we make it better? How do carriers make an impact on the claim, instead of just hitting their audit marks for best practices?
I have dealt with claims professionals for a long time, and over the years I think I have a pretty good idea of what the adjuster would want if given a “perfect world” scenario. This list is probably a dream, and chances are no carrier would ever allow this to be the standard of how they handle claims. But, maybe if a few of these items were to happen, who knows what the impact would be on the profession as a whole? I am only going to go in to a few points here, because this list could be pages and pages long. Keep an open mind, and imagine the possibilities if……….
The handling adjuster has the freedom to assign whatever vendor they prefer.
This is an easy one. For example, I know plenty of adjusters that avoid using surveillance because they dislike the vendor they are forced to use. Adjusters feel the SIU vendor is not aggressive enough, they do not communicate enough, or the results just never seem to be there. On top of that, most adjusters are only allowed to complete a day or two of surveillance and hope they hit a jackpot. This is rarely the case, so it sours the entire experience.
But let’s say they have the freedom to use whatever local vendor they wish. Every claims person knows the SIU team they wish they could use, because at a prior carrier they had great success with them. But at Carrier ABC, they are forced to use SIU vendor X, who never seems to get the job done.
The adjuster keeps the file from day 1 until the file is over.
Another pet peeve of the adjuster is that once they complete all of the dirty work and investigative tasks, it is then transferred to another adjuster to take it over from there. I cannot tell you the complaints I hear of an adjuster who set a file up to settle after spending countless hours on it, only to have the file transferred to another adjuster. The new adjuster then gets to bask in the accolades for a job well done come file settlement. Sadly the reality is that the new adjuster really just made a few phone calls.
Plus when the file is transferred after a period of time, the claimant gets confused. This confusion can derail many things, and it probably hurts the claim rather than help it. Carriers have their reasons for transfer, but I could never see the benefit in moving the file from a qualified experienced lost time adjuster to yet another qualified lost time adjuster. Why not just keep it where it is? Adjuster 1 has already established a relationship with all involved parties. Why start over?
If the adjuster wants to go in the field to perform accident investigations or to complete a recorded statement in person, then let them go do it.
Permitted if geographically possible, if the adjuster wants to go size a claimant up by doing a statement in person, why are they not able to do so? Details obtained over the phone only go so far. You really cannot truly investigate all aspects of the claim via the phone. Do you know what the machine looks like that injured the claimant? Where were they standing? How were they operating the machine at the time of the injury? Without being able to actually see these details, I do not think an investigation is truly completed.
Provide claim assistants to help the adjuster manage their time.
Maybe the most important, I hear from adjusters that they have to spend too much of their time doing clerical work, instead of actually working on their claims. This can range from coding bills, to processing mileage checks, to completing forms, calculating wages, and so on. These are all tasks that could be completed by a claims assistant. This frees up the adjuster to work on the actual claim compiling investigative data, discussing cases with Counsel, and so on. Even though the positives of providing such a service to the adjuster chart off the paper, carriers are reluctant to provide little if any assistance to the adjusters. If you ask me, the adjuster has more important things to do instead of sitting on hold with a doctor’s office waiting to talk to a person to request medical records.
I have only scratched the surface here. In a perfect world, think about how efficient the claims adjuster could be. How proactive they could be. How their insight and approach towards claims could differ when given the time and resources to focus on the claim itself. The possibilities are endless.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. http://reduceyourworkerscomp.com/about/. Contact: firstname.lastname@example.org.
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