5 Tips To Reduce Your Stress and Be More Productive

 

I think it is an understatement to say that claims professionals are under a lot of stress.  Nowadays adjusters are forced to do more with less, so in addition to the normal claim investigations they also have to do a billion other things along the course of a normal day.  Add in to that rigid auditing standards, service promises, increased claim counts, and the list goes on and on.

 

Below we talk about some easy ways to take some of the stress out of your life in order to improve your work-life balance.

 

 

  1. Don’t Get Intertwined in Social Media

 

In today’s world, everyone is a mouse click away.  Social media such as Facebook, Twitter, LinkedIn, and so on have made it possible that you can be connected to everyone, at all times, and the stresses of other people can become your stressors as well.  In fact people can reach out to you and vent about their own problems, which can take time away from whatever project you are working on.  So limit your social media interaction during work hours, and focus on the task at hand.  If you choose to get involved in a Facebook discussion about some hot political topic, do it away from work on your own time when it will not distract you as much.

 

  1. Leave Your Desk For A While

 

I know plenty of adjusters that work 10-11 hour days, and they rarely leave their desk except to go to the printer or to hit the bathroom.  Not only is this crazy, but it is also not healthy.  Getting up and walking around for a bit can be relaxing, especially if you can head outside for a while and get some fresh air.  Maybe go out to lunch every now and then and get away from that office atmosphere.  You don’t have to do it every day, even one or two days a week can make a difference.  The world is not going to fall apart just because you snuck out and got a piece of pizza on your lunch break.

 

 

  1. Decrease Your Social Engagements If Possible

 

Don’t get me wrong, heading to seminars or after work engagements can be a great way to network and share some down time with your friends or work peers.  But you have to keep your events in check.  If you have a crazy week and need the time to focus on other things, don’t be afraid to skip out on an engagement or two.

 

This can especially be true if you have kids that are active in sports or other things that can occur after your work hours during the work week.  Maybe the thing to decrease is the amount of activities they are involved in, since you have to be the one to pick them up and drive them to basketball practice.  Your kid doesn’t have to be on 3 basketball teams during the summer, and in doing this you can decrease their own time stressors as well. Or let them skip a few practices and go out for dinner, or go to a movie and spend some quality time with your children.  If they miss a practice or two I doubt that their ability to hit free throws will decrease.

 

 

  1. Put a Cap on the Hours You Spend at Home Working

 

Many adjusters and other professionals have the ability to access their work from any computer at any time.  This is a great thing to have when you need it, but it shouldn’t be something that you have to engage in all of the time, every single night, and every single week. If you fail to complete a few diary items, your employer is not going to go out of business and lay everyone off.  You have to prioritize what you HAVE to do at home after work hours, and what you COULD do.

 

The hard part here is that the life of a claims adjuster is never caught up.  Rarely can any adjuster be totally done with everything on every file at any given day. It’s like a constantly spinning wheel.  But there are plenty of things that can wait until tomorrow.  Your time after work is just that—your time.  If you choose to spend it plowing through countless medical records for a file then fine, but ask yourself if this is something that has to 100% be done right now and cannot wait until the following day back at the office.

 

 

  1. Take Time to Enjoy Your Hobbies, or Start a New One

 

If you love to golf, and you have had to skip your golf league the last few times because of working late, you need to make sure your time is a priority.  Working late can sometimes be unavoidable, but that doesn’t you can’t hit the driving range after you are done.  Whether it be hitting golf balls, hiking at the park, bowling, or going for a run, take the time to enjoy your hobby of choice.  Don’t put off that time and spending it in front of a computer.

 

These sports and hobbies are things you do to unwind and take your mind off the daily stress.  Not only will doing this reenergize yourself, but it will give you that quality “Me” time that everyone needs. Pencil that time in the calendar, and be sure to stick to it.  Make that a priority for once, instead of pushing it back time and time again.

 

 

Summary

 

In this profession we are all faced with a lot of different stressors, and they come at you from all angles.  Injured workers are stressed out because their balance of life is off due to an injury.  They are no longer working, no longer being productive, and they are worried about getting their own lives back in order.  So we not only have to deal with our own life stressors, but we have to figure out a way to try and solve the stressors of our claimants day in and day out.

 

Most of the adjusters use the excuse that “If I take some vacation time away from the office my workload only gets worse, which puts me farther and farther behind.” Part or all of this may be true, but you get vacation time or paid time off for a reason.  Nobody can work 365 days a year without going insane.  Pencil that time off in your calendar and stick to it.

 

 

Author Michael B. Stack, CPA, Director of Operations, 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.  www.reduceyourworkerscomp.com.

Contact: mstack@reduceyourworkerscomp.com.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

How To Ensure Your Adjuster Is Being All They Can Be

If you have ever felt an adjuster assigned to one of your workers’ compensation claims was not making a proper effort to investigate a questionable injury claim, you are not alone. Every large claims office has some really good adjusters, some acceptable adjusters and some unmotivated adjusters who are just going through the motions to make it to the next weekend.

 

If you contact an unmotivated adjuster about the status of their claims handling, the adjuster will tell you, that she is doing everything she can on the claim. The reason the adjuster will say that is because the adjuster knows that the employer most often does not know what can be done on the claim. If you want to really shake up the unmotivated adjuster and to get the adjuster moving forward full speed on the investigation of the claim, review the following list of investigation suggestions with the adjuster.

 

Check List of Investigation Tools:

 

• Employer’s First Report of Injury form

• Employee’s written report of claim form (in states where it is required)

• Insurance Services Office filing (formerly known as the Central Index Bureau)

• Contact with claim adjuster(s) on claimant’s prior work comp claims

• Contact with prior employer(s) on claimant’s prior work comp claims

• Medical records from claim files of prior work comp claims

• Contact with work comp board/industrial commission for their records on prior claims (some states will not cooperate, other states do cooperate)

• Employee’s detailed recorded statement

• Recorded statement of any witnesses to the accident

• Supervisor’s recorded statement

• Police report on vehicle accidents

• OSHA reports, whether federal OSHA or a state OSHA

• Any other government agency records

• Discussion of the claim with the employee’s attorney, if the employee is represented

• Contact with any third party involved in the claim – driver of other vehicle in auto accidents, manufacturer of machinery that injured employee, manufacturer of defective product that caused employee’s injury, etc

• Telephone contact with each medical provider to have the most recent medical report(s) faxed to the adjuster

• Medical records for all medical appointments

• Photographs of the accident scene

• Diagram of the accident scene

• Having the claimant call the adjuster after each doctor’s appointment to report on medical progress

• Nurse case manager’s input on serious injury claims

• Field case manager to meet with the employee and doctor, and to attend medical appointments with the employee

• Review of claimant’s social media sites – Facebook, Twitter, LinkedIn, etc.

• Employer’s personnel file on the employee, including job application, new employee forms, disciplinary records, etc.

• Employer’s safety records for the accident location

• Employer’s public notice of plant location closing, lay-offs, union issues, etc.

• Referral of the claim to the Special Investigation Unit (the unmotivated adjuster may be quick to do this, as this passes the buck to someone else to do a complete investigation).

• Outside Vendor Services (Investigation steps that can be taken, but not normally performed by the adjuster, but overseen by the adjuster).

• Surveillance

• Activity check

• Neighborhood canvass

• Background check

• Credit check

• Public records review / civil records searched

• Criminal records check

• Skip tracing

• Clinic records sweep (checking for medical treatment at all clinics in the area of the employee’s address)

• Hospital records sweep (checking for medical treatment at all hospitals in the area of the employee’s address)

• Pharmacy records sweep (checking for prescriptions filled at all drug stores in the area of the employee’s address)

• Video re-enactments of the accident

• Examination under oath

 

Unfortunately, there is no central system where an adjuster can check to see if the employee is currently working another job. The use of a private investigator for surveillance can fill this void, but without knowing where an employee might be working, this is often a hit-and/or-miss approach.

 

It would be a very rare claim where it is necessary for the adjuster to take all of the investigation steps listed above. The key to an investigation is for the adjuster to take as many of the investigative steps as needed to verify the validity of the claim, or to disprove the claim.

 

We realize this checklist of the investigation steps your adjuster can take is incomplete. We welcome our readers to contact us with additional investigation techniques they would add to our investigation checklist.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.

 

 

 

Editor Michael B. Stack, CPA, Director of Operations, 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. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

 

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

10 Helpful Tips For Managing Angry Work Comp Claimants

You are never going to please all people all of the time.  Nothing could be more correct, especially in the insurance industry.  The claims profession is littered with conflict over many things right from the start.  Experienced professionals know how to properly diffuse a tense situation.  But it is an asset that is learned over time.

 

Here are a few important tips to remember:

 

  1. Stay Calm

 

Regardless of the negative attitudes or unpleasant tones an angry caller may have, it is essential that you do not get emotional as well.  Using phrases such as “I hear what you are saying” or “I understand” can help to calm angry callers.  Remember they usually have no idea what is going on or why these decisions are being made on their claims, so take the time let them vent a bit then calmly explain to them the situation.

 

 

  1. Listen & Be Patient

 

Do not attempt to interrupt angry callers.  Be patient and let them finish speaking.  Sometimes they just need to vent their frustrations.  After that they will relax a bit and work with you to resolve their issue.  Explain to them what is going on, and what options they may have for moving forward.

 

 

  1. Remain Professional

 

Above all remain professional.  Remember you are in the customer service industry, and there is a lot of competition out there.  Every phone call should be dealt with in a professional matter, no matter the conversation.

 

 

  1. Do Not Raise Your Voice

 

Raising your voice or talking in a sarcastic tone is only going to irritate your claimant further, which will resolve nothing.  If anything, you can get in trouble with your supervisor.  Many carriers record telephone conversations, and if this discussion gets pulled for review you are going to look foolish.

 

 

  1. Try Not to Argue

 

Your main goal in diffusing a heated conversation is to resolve the problem.  But a direct argument will rarely resolve anything.  Instead, explain to them what is going on, and what they can do to help themselves.  It may be that getting medical records or a more detailed report from their doctor is the piece of evidence you need to complete your investigation.  Remember the claimant does not have the experience that you do in handling claims day in and day out, so cut them some slack and try to help them instead of just arguing point/counterpoint.

 

 

  1. Speak Slowly and Clearly

 

Nobody likes to have to repeat themselves, so speak in a clear voice.  Also try to avoid talking in legal terms or in claim shorthand.  The claimant will probably have no idea what you are talking about, which will frustrate them.  Pretend you are explaining the issue to someone who has zero experience in this situation, and you may end up with better results than you planned.

 

 

  1. Empathize & apologize

 

How would you feel if you are in the same situation?  What would you want to be said to you to make you feel better about the call?  Claimants want to know that you understand where they are coming from, and they want the reassurance that you can help them with whatever issue they may have. Even if you know the caller is wrong, take a moment and apologize for the confusion.  Many callers simply want acknowledgment from the carrier that a mistake may have been made, if applicable to your scenario.  An apology is the first step to overcoming their anger and opening a dialogue about resolving the issue.

 

 

  1. Offer Solutions

 

People are coming to you with questions about their claim, or why a decision was made.  But oftentimes these decisions are not written in stone.  Denied claims can be accepted later, and vice versa. Maybe your claimant can file for mediation on their denied claim.  Or maybe they did not submit enough information in the beginning for their claim to be accepted.  Whatever the reason may be, explain to them what options they have for moving to the next level.  If you cannot answer a question immediately, let them know that you will work on it and get back to them with some answers or options and go from there.

 

 

  1. End the Call if the Person is Repeatedly Abusive

 

Your goal is to bring a successful closure to each phone call.  However, you do not have to tolerate abuse.  Kindly interject with an “Excuse me” if necessary and inform the caller that their language or behavior is not acceptable, and it will not help them resolve their conflict.  It is well within your ability to end the call if the person continues to be belligerent and abusive if you have asked them to calm down several times beforehand.

 

 

  1. Do not take it personally

 

In the end, this is your job.  A lot of claims adjusters have a lot of hours of work invested into each file, and sometimes they can wear their heart on their sleeves.  But at the end of the day, you have to accept the decisions you made on a claim.  I recall a young adjuster I knew that was first starting out in work comp, and he used to agonize over his decision about whether a claim was compensable or not, and if he was making the right call.  This is a good asset to have, but only if it is a healthy concern.  The process that is in place with supervisor reviews and audits is there to catch your errors, if you have any, and to help you make confident decisions on claim outcomes.  Trust in the process in place, and believe in your decisions that you make. Sometimes you have to go with your gut decision.

 

 

Summary

 

An adjuster is on the phone for the majority of their day, every day.  And in the field of claims, conflict will arise.  There is just no way to avoid it.  But you have to be armed with the proper way to handle yourself on the phone–not just for certain calls but for every call.  Implement the tips above, and hopefully you will be known around the office as a person that can diffuse any tough situation that is thrown their way.  Knowing how to work the phone is one of the best assets an adjuster can have.

Author Michael B. Stack, CPA, Director of Operations, 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. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional about workers comp issues.

What To Do When Your Workers Comp Employee is Seeing Their Primary Care Doctor

 

Often times in workers comp cases, injured workers will go treat with a primary care physician, even if that is technically not allowed This is due to the fact that there is a negative stereotype attached to “clinic doctors” or what many workers call “the workers comp doctor.”  Contrary to popular belief, these doctors do not work for the insurance carrier.  Sure, these physicians may seem more aggressive than the primary care doctor, but that is for several reasons.  The most important one is being that they have no vested financial interest in obtaining a comp case as a long-term patient.  The old adage goes that “treating doctors get paid to treat”, and they like to keep the waiting rooms filled up day after day, and they do so by not being as aggressive as necessary. 
So what if the injured worker is able to skirt around the system and run to a primary care doctor?  Is the employer stuck with this doctor forever, and what can be done to keep the claim moving forward?  How should one go about getting the information needed for the claim? (WCxKit)
 
1. If this injured party has had prior treatment for this complaint with this doctor, be sure to request a copy of the chart and ask for all records.
Say this worker has had similar complaints of back pain in the past, and the records show that he did treat with this doctor in his past comp claims.  This means that with a signed medical release, the doctor should grant access to these records, and any other records that pertain to back treatment.  If this doctor has dictated notes, it can yield several clues of possible injury outside of the course and scope of employment. This of course is solid ground for a dispute on the case, since you the actual injury may not be related to the worker’s actual employment.  
Also included in the notes will be objective evidence of what actually is wrong with this patient.  If he has all subjective complaints, then that injury may not be as severe as the claimant is suggesting. The bottom line is gathering medical records can provide several medical clues as to what is happening and  will only help the case.
 
2.  How does this doctor relate this injury to the patient’s stated injury that arose out of employment?
The main key in any comp case is the causal relation statement.  This is where the doctor takes the subjective and objective complaints and evidence, and ties them back to the worker’s employment.  A lot of primary care docs that do not have a lot of comp experience will purposely be as vague as possible when it comes to this issue.  A common statement a doctor will make is one similar to “The patient did not have any prior complaints of injury other than something happening at work; therefore, it must be work related.”  This is not exactly true, since even though a person may be at work and have pain, it does not mean the work actually caused the pain or injury.  Sure, work can contribute to this scenario, but the adjuster has to get to the ultimate cause.  If a person has back pain, and there is a strain injury at work, it does not necessarily mean that the carrier has to pay for surgery that corrects degenerative conditions. Work may have exacerbated these pre-existing medical conditions, but it is a stretch to say that work actually caused the arthritis.  It is possible is a few circumstances, but overall the common result is admitting that work caused a temporary exacerbation of a pre-existing condition. 

 
3.   If performing an IME or Peer Review that disagrees with the treating doctor’s causal relation, and the treating doctor disagrees with the IME doctor, how is that primary care doctor addressing this issue and what evidence are they using to solidify the opinion?
The second most common scenario is an IME doctor disagreeing with the primary care doctor’s opinion of causal relation. This is when claims will head into litigation, since there is a medical dispute about the origin of the injury.  We have seen a lot of treating doctors say they disagree with the IME doctor, but then they do not elaborate.  If this is the case, the adjuster will almost always side with the IME doctor, terminating medical coverage for this injured worker. In the occasion that the treating doctor makes an argument but still disagrees with the IME doctor, they may agree to disagree.  Again this helps the adjuster, because that adjuster will side with the IME doctor, and overall it will take a Magistrate to make the final opinion on which doctor they find more credible.  As the doctors are going back and forth arguing about who is correct, try to see what the treating doctor is using as the basis for the opinions.  It should be objective medical evidence, and not based on subjective complaints.  If it’s all subjective complaints, then that will only strengthen a suspension. 

 
4.  Is the treating doctor providing medical slips and records on a timely basis to support the worker being disabled?
If the answer to this question is yes, then the adjuster must dig deep to find evidence contrary to what the doctor is opining. This can be in the form of prior injuries, auto accidents, surgical records, etc.  Try to find good solid evidence that the treating doctor does not know about, then submit it and ask if the opinion changes.  
If the treating doctor is not supplying the necessary documentation needed, then there are grounds to suspend treatment with this doctor until the documentation required is received to make a decision on the ongoing compensability of the claim. Most claimants will get frustrated if their treatment is suspended.  Their doctor may be telling them the injury is work related, but there is no supporting documentation to draw that conclusion. 
 
5.  Use of covers letters and nurse case management
After all of the attempts to gather the information needed, there is still a dead end.  So what to do now?  One option is to draft a concise cover letter to the treating doctor outlining concerns.  Doctors like to know what they have to address in comp cases.  Every doctor has a unique style when it comes to these issues.   The treating doctor may actually help a defense if you draft a neatly organized cover letter outlining the facts of the case with the questions concerning the compensability.  Since the adjuster is not in the room when this patient is being seen, who knows what the worker is telling the doctor?  Another way to confirm these facts is using an onsite nurse case manager. The nurse can talk to the doctor before and after the appointment, and can be very useful in getting the information needed pertaining to any medical documentation desired.  The nurse may not be able to actually be present in the room during the exam, but talking to the doctor before and after the appointment may help connect the dots between what medical evidence is showing, and what the patient is actually complaining of in regards to the injury.  Coming to these conclusions will only help the adjuster arrive to the proper decision on the compensability of the claim. (WCxKit)
Summary
If the injured worker is treating with a primary care doctor not familiar with the comp system, be careful and thorough about gathering information.  Be sure to put the time in on doing a detailed background investigation and pass that information on to the treating doctor, so they can see exactly what you are seeing.  This will help them make the correct opinion on the overall compensability of the claim.  If the attempts fail, utilize an IME and nurse case manager to help bridge the process. The adjuster can never have enough information when it comes to making the proper decision on claims.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

Editor Michael B. Stack, CPA, Director of Operations, 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.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Why Worker Comp Litigation Stalls and How To Get it Moving

Litigation can happen in any workers compensation issueNot on every claim, but if there is an aggressive carrier/TPA that denies cases, it will lead to legal hearings over decisions the adjuster made on the claim.

 

 

 

Some cases in litigation are more complex than others, all with varying personalities involved. Some plaintiff firms and adjusters are more aggressive than others. There are always many outside factors involved once a claim moves into litigation. The overall goal of the carrier/TPA is to end the litigation by paying out the least amount of exposure as possible. On the other side, the goal of the plaintiff is to net as much money or benefits as possible. This conflict in interests can lead to months upon months of legal “back and forth.” But what can stall out progress on litigation? [WCx]

 

 

  1.  The employee is not realistic 

Litigation leads to a lot of bitterness from the injured workers. They feel resentful about having to get an attorney to assist in getting “what is theirs,” including benefits, be it medical or indemnity in nature. Most of the time when the adjuster asks for a plaintiff demand on what could resolve the case; it is something that is unrealistic. Either the employee wants a big wheelbarrow full of money, or some medical treatment that the carrier does not feel is required to pay. Plaintiff counsel works for the client, the injured worker. Even if the adjuster puts forth a fair settlement offer, and even if the plaintiff counsel feels it is adequate and fair, the injured worker may reject it. Sometimes plaintiff attorneys have a problem controlling the client, stalling out litigation for sure. In the end a judge may have to decide what is or is not fair. Carriers hate to risk going to a judge, but sometimes it is the only way. Most judges will want the two sides to work it out among themselves, but it just cannot happen in every case.

 

 

  1.  The employer wants to play hardball 

The employee is not the only party to play with unrealistic expectations. Sometimes the adjuster is faced with an employer/insured who is just not reasonable, no matter how much the issues are broken down. Sometimes personal issues are intertwined within a workers comp case, and if the employer has a bone to pick with the employee, or an example is being made out of that person to scare off other employees from pursuing litigation, it will not help the case end quickly. The judge will have to become involved and this can backfire on the employer. At the end of the day, the adjuster has to get the authority from the employer to settle the case for a certain dollar amount. Even if it were to be a fair amount for all parties involved, the employer can always pull rank and steer the claim off track.

 

 

  1.  The attorneys involved are not being proactive 

A busy law firm has many cases, sometimes spread across the state in which there are cases on the docket. Super busy law firms with many attorneys just cannot make it to every legal hearing or mediation, which leads to that mediation being rescheduled. Quickly, 90 days can go by without anything being done on either side. This can be true of both defense and plaintiff law firms. And if the two busy sides are put together, the case is not going to be going anywhere anytime soon. It is the job of the adjuster to maintain the reins on the defense attorney, and force the issue to be addressed a timely manner. There are a lot of defense law firms who are willing to do whatever the employer requests, and if the current firm is having an issue with attendance, then something needs to be done right away. It is not allowable for the adjuster to just pass the case over to the defense attorney and let it go from there. When an employer starts to see a trend with ongoing litigation, sound the horn and become more involved. Lean on the adjuster to find out what is going on. Legal expense is not cheap, and employers should be paying for legal services that are acting in their best interest.

 

 

  1.  The adjuster is not open to settling cases 

Employers dealing with adjusters who are not settling cases have a serious issue. Sometimes cases are compensable and can cost a lot of money. The adjuster may not be willing or happy to accept this, but it is part of the job. If settling a case is an option to end exposure, and the adjuster is not being realistic and following wishes, then bring that up to the adjuster’s supervisor. The good news is, most cases in litigation involve the supervisor anyway. But everyone is busy, and sometimes the supervisor can overlook what is going on. It is hard to stay on top of every single case, so if there are some concerns on where the case is heading or how it is getting there, then voice an opinion. The adjuster and carrier work for you, and they are there to assist with these legal issues and to act in the best interest of an employer. If the adjuster is refusing to have an open mind and to accept the fact that all cases cannot be tried, then maybe a new adjuster is needed. Because in the end, it is the employer who will be damaged by a bad legal outcome. The carrier will move on, the attorneys will move on, and the employer needs to be comfortable with the way the litigated cases are being handled.[WCx]

 

 

Summary

Litigation is unavoidable. It will happen, sometimes more often with certain employers than others. But that does not mean that the litigation process has to be painful. Litigated cases need to be handled correctly, since one bad move can result in a lot of money being paid out unnecessarily. Keep the litigation moving, keep involved, and be prepared to handle litigation when it happens.

 

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, 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.  www.reduceyourworkerscomp.com.  Contact:  mstack@reduceyourworkerscomp.com.

 
WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Four Biggest Mistakes of Workers Comp Claim Adjusters

 

 
Adjusters are faced daily with the task of making many different decisions on many different types of claims.Every claim is in different stage it is easy to lose track of some of them. 
 
 
Mistakes can come in a variety of different scenarios, and below we discuss four common oversights that the adjuster can make.[WCx]
 
 
1. Wage calculation errors
Many adjusters handle claims in more than one state at a time. Each state has its own way of calculating wage loss (See our State by State guide here for information on your jurisdiction), and some are more intricate than others. Because of this, it is common for an adjuster to make an underpayment or overpayment due to these differing wage calculations. 
 
 
The most common mistake within this realm is a waiting period calculation error. Almost every state gives the employer and carrier a chance to get the injured worker back to light duty work before having to pay full wage loss benefits. Using Michigan as an example, there is a two-tiered system: the first 7 seven days are the actual waiting period where no wage loss benefits are paid. This gives the employer time to obtain medical restrictions and to find a replacement job. The worker has to accrue this time as being totally out of work.
 
 
On the 8th day the benefits for wage loss begin.   If the claimant is still out of work after 14 days, then he also picks up the first 7 days of missed wages. 
 
 
In Wisconsin there is a 3 day waiting period (See Wisconsin law) and pay benefits start on the 4th day,.  If the claimant is still out of work after 7 days, the first 3 are picked up and paid.  
 
 
Each state has its own way of calculating wage loss, and it is easy for an adjuster to confuse the waiting period duration. Some states also have other little sidebars, saying that if light duty work is offered and refused, then of course no wage loss will be paid. But how was the job offered to the employee? Was a certified letter mailed and received by the employee? When was it mailed? Did a supervisor just leave a voicemail for the injured worker to come in to work? As you can see, there are a lot of variables within the wage loss genre. The best advice is if there are questions about whether wage loss should be paid, consult local legal counsel.
 
 
2. Failing to file State forms timely, resulting in a penalty fine
The filing of state forms is similar to the wage loss waiting period.  Some states have a very strict time period which an adjuster must file forms indicating that benefits have or have not been paid.  If the adjuster fails to do so, the carrier may receive a nominal fine that must be paid to the State. Some States have no fines at all in this regard.
 
 
Even more severe is the failure of the carrier to report a claim to Medicare when the worker is receiving workers compensation medical and wage benefits. At the time of this article, the fine is $1,000/per claimant, per day. Obviously because of the amount and penalty, carriers are very vigilant about making sure to get the required information on the claim to Medicare, but a lot of times this is the duty of the adjuster. The employer is not really affected by this measure, but it is a very important thing to be cognoscente to ensure all parties are aware than an injured worker is a Medicare recipient as well.
 
 
3. Failing to follow up with a treating doctor or IME doctor
Since the adjuster has several irons in the fire at once, it is very common to forget to follow up with the doctor. Failure to get the IME report needed can result in an overpayment of workers comp wage loss pay. If the IME was 5/1/12, and the report is not gotten until 6/1/12;  the worker can easily be overpaid if the IME terminated benefits due to the worker no longer being injured (since the benefits should not be received at all). Some states require the employer to pay wage loss until the IME report is received, and some only require payment until the actual IME appointment date. Be sure to know what the payment requirements because failure to do so may result in a fine against the carrier and/or bonus wage loss pay to the injured employee.
 
 
4. Failure to pay wage loss benefits timely upon completion of the investigation
Most states give the carrier and adjuster time to investigate if a claim will be compensable. If the adjuster needs more time, most states require that a form be filed for an extension to the investigation. Failure for the adjuster to file that form can result in a fine.  This is usually payable to the injured worker in the way of extra wage loss benefits to compensate the worker for the time without pay, especially if the claim is deemed compensable. Many states vary wildly in this regard, so consult local counsel on questions regarding investigation timeframes and when the best time is to file for an extension. [WCx]
 
 
Summary
These 4 topics discussed above only scratch the surface on potential errors an adjuster can make during the life of a claim. Just because someone is an adjuster does not mean that they are necessarily a great one. Being an adjuster means juggling many things at once, and meeting the employer’s best interests when dealing with the claims of injured workers. 
 


 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, 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.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Good Adjusters Know When to Settle Your Workers Comp Claims

The number one distinction between the excellent workers compensation adjuster and the average adjuster is the ability to distinguish when the claim should be settled. The lazy or indifferent adjuster will often push to settle a workers comp claim quickly, regardless of cost. The excellent adjuster will also want to get the claim settled quickly, but will be patient for the most opportune time to settle thus minimizing the overall cost of the claim. The excellent adjuster will have a working knowledge of the underwriting of workers compensation coverage and realize the amount spent on each claim has an impact on the employer’s workers comp insurance premium.

 
 
The professional adjuster starts moving the claim toward settlement immediately upon receiving the new injury claim. The adjuster understands everything that is done on the claim can impact the settlement, whether it is confirming coverage, making initial contacts, completing a thorough investigation, obtaining medical information, or arranging the return to work or any other action taken by the adjuster.  The adjuster knows that by following Best Practices throughout the claim handling, the most economical settlement will be reached. [WCx]
 
 
The adjuster has to walk a fine line in the settlement of the claims. The adjuster has the task of making sure all applicable workers compensation benefits are provided to the injured employee while at the same time being sure the correct amount is paid on every benefit provided whether it is medical treatment, indemnity benefits, vocational rehabilitation, legal fees, or other expenses. The biggest potential for a mistake on the overall cost of the claim is the decision on when and how to settle the claim.
 
 
 
In almost all situations it is not to the employer’s/insurer’s advantage to consider settlement of the claim before the employee has reached maximum medical improvement. If the employee is anxious to settle the claim before the medical provider has provided a long-term perspective on the employee’s future medical status, the adjuster should consider the effort to settle the claim prematurely as a red flag waving, and carefully review the validity of the claim.
 
 
There are three financial consideration questions the adjuster should utilize in determining when to settle the claim. 
 
  1. Is there a cost savings by settling the claim now versus continuing to pay weekly indemnity benefits and on-going medical cost?
  2. Will settling the claim now eliminate unnecessary legal cost?
  3. Will settling the claim now eliminate the risk of a more adverse outcome?
 
 
When the employee has reached maximum medical improvement and has been given a disability rating, the workers compensation statutes of the jurisdiction will specify how much the injured employee is entitled to in compensation. Consider the employee, who as a result of his injury will never be able to return to any type of employment. For example, the state limits disability benefits to 500 weeks, and 100 weeks have already been paid to the employee. If the employee’s weekly benefit is $600 and the employee will be paid for another 400 weeks, or a total of $240,000, does it make sense to settle the claim now or is it better to leave the claim open for 400 more weeks? 
 
 
The answer depends on the amount the employee/employee’s attorney is willing to settle the claim for. The settlement amount must be equal or less than the present value of the money the insurer would invest to produce the income stream needed to pay the employee. For instance, the insurer would need to invest $200,000 to produce the income stream over the 400 weeks. If the employee wanted to settle the claim for $175,000, it would be in the best interest of the insurer to settle.  However, if the employee demands $225,000 to settle the claim; the insurer would do better to continue to pay the $600 per week, as their eventual total cost of the claim would be less.
 
 
A common mistake made by adjusters is to litigate the claim when the claim should be settled. If the adjuster has properly established the settlement value of the claim, the time to resolve the claim is when the settlement value has been established, not months or years later after extended litigation. If there is nothing to be gained by delaying the settlement further, the time to settle the claim is when the value of the claim can be established, whether or not the claim is in litigation.
 

My general rule of thumb is: if the claim is going to be settled, do it now rather than later, because every week the claim is ongoing indemnity costs are being paid, so why wait an extra 6 months vs. settling it now, assuming  all other things are equal.

 
 
This is assuming that the employee’s attorney will encourage the employee to settle for the proper value of the claim. There are plaintiff attorneys that will intentionally refuse to settle the claim for the proper value in an effort to extort additional compensation from the insurer. In those cases, the adjuster is better off not to settle the claim until the employee’s attorney is willing to encourage a fair settlement. If the adjuster overpays on the claim to get it settled, the plaintiff’s attorney will remember and make excessive settlement demands on all future claims with the adjuster and/or insurer.
 
 
There are situations where it is better to settle the claim for what could be considered a high amount. For an example, the employee was seriously injured. The medical provider has placed the employee at maximum medical improvement with a fairly high permanent partial disability rating. The employee’s attorney is maneuvering to get the employee declared to be permanently and totally disabled. The medical information and vocational information is such that there is a possibility that the employee could be found to be totally disabled by a workers comp judge. To avoid what could be a much larger settlement, the adjuster (normally with the concurrence of the claim office management) will make a decision to settle the claim for a higher than normal amount to avoid the potential of having to pay even more due to adverse ruling on the claim if it is not settled.[WCx]
 
 
Overall, the time to settle the claim is when the most economical outcome will be produced.  The adjuster should always keep this in mind once the employee has reached maximum medical improvement.


 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

22 Things Your Workers Compensation Adjuster Should Not Do

Self-insured employers often get into trouble for not being knowledgeable of the requirements of the Unfair Claims Practice Act in the state(s) where it is being self-administered for workers compensation claims. The failure to act in a totally ethical manner can lead to litigation by the party wronged and to fines and/or the suspension of the self-insured’s authorization to be self-insured by the State.

 

 

The workers compensation adjuster, who is often dealing with attorneys out to maximize the cost of the workers comp claim, or with employee claimants who are attempting to commit fraud, may be tempted to fight fire with fire. The adjuster should always handle the claim in a totally ethical manner.  If an adjuster is doing any of the following, stop everything and discuss the adjuster’s actions with the adjuster. [WCx]

 

 

Unfair claim practices by the adjuster include:

  1. Knowingly misrepresenting the benefits available under the state’s workers compensation law
  2. Failing to contact the injured employee (hoping the employee will not pursue the claim)
  3. Failing to investigate the claim properly
  4. Denying compensability without a valid reason
  5. Failing to file all necessary state forms
  6. Recording the employee’s statement when the employee is under the influence of medications or distracted by pain
  7. Failing to provide a copy of a recorded statement or written statement when one is requested
  8. Recording telephone calls without the other party’s knowledge of the call being recorded
  9. Knowingly documenting the file notes with inaccurate information
  10. Intentionally not returning phone calls of the employee or medical provider in an effort to discourage the claim
  11. Failing to pay indemnity benefits timely trying to coerce the employee in to returning to work prematurely
  12. Failing to authorize needed diagnostic testing without reason to not authorize
  13. Failing to pay for permanent partial disability
  14. Paying less than the workers comp statute calls for when settling a permanent partial disability
  15. Offering to settle and close out future benefits for an amount significantly less than what the adjuster knows to be fair
  16. Advising the employee not to hire an attorney
  17. Threatening to reduce the settlement of the claim if the employee hires an attorney
  18. Discussing any aspect of the claim with an employee known to be represented by an attorney
  19. Settling the claim before the extent of disability is known
  20. Overstating the damages and exposures so that the adjuster’s supervisor will extend excessive settlement authority, allowing the adjuster to make a quick (but overpaid) settlement
  21. Providing the employee’s personal information to parties who do not have a legitimate need to know
  22. Having a financial interest in any vendor utilized on the claim

 

Mistakes, oversights, and poor claim handling are not unfair claims practices. The workers compensation adjuster often has more work to do than it is possible to get done. With the telephone ringing constantly, the e-mail flooding in, having numerous deadlines for filing forms, numerous deadlines to prepare for mediations or conferences, and numerous other items that need to be completed, it is normal for some things to fall through the cracks. When the adjuster does not contact the injured employee timely, or does not respond to a settlement demand from the employee’s attorney, it is normally because the adjuster has more to do than is possible to get done. It only becomes an unfair claims practice when the adjuster intentionally decides not to take a needed action in an effort to impact the overall outcome of the claim. [WCx]

 

 

Almost all adjusters are honest and have the best interest of both the employee and the employer at heart. If you do notice any of the above 22 issues occurring, stop and discuss the issue with the adjuster. Often there is an ethical and valid reason for the adjuster’s action which will become apparent when you learn more about the reason for the adjuster‘s actions. Only when the adjuster sets out to act dishonestly should you be greatly concerned.

 

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 


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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

 

Stair Stepping Reserves Occurs When Work Comp Adjusters Ignore Claim Basics

Whenever a claim quality auditor or actuarial auditor sees numerous small upward changes in the workers’ compensation claims reserves, he knows he has a case of an adjuster stair-stepping the reserves. If you draw a graph of the reserves, it looks like a set of steps—flat, up, flat, up, flat, up

When the adjuster keeps raising the reserves in relatively small increments to pay medical bills, indemnity or expenses, a basic principle of accounting is ignored. Sound accounting for an insurance company or self-insurer is to set aside money to meet the financial obligation brought on by the claim against the insurance policy. When the adjuster does not establish the correct reserve, the insurer’s financial balance sheet is inaccurate, either overstating or understating its assets. With stair-stepping of reserves, the insurer assets are overstated on the balance sheet, as the liabilities—the claim where the reserves are understated—are incorrect.

The ultimate cost (also known as total cost) of the workers compensation claim is the amount that should be shown on the reserves at all times. When the claim is assigned to the adjuster, all the information needed to establish the ultimate cost of the claim is not known to the adjuster, hence there will often be changes in the amount of reserves over the life expectancy of the file. The initial reserves should be based on the adjuster's experience with similar claims, but as facts change – the employee has surgery, the employee's level of disability is greater or lesser than normal, the claimant has co-morbidity issues that lengthen the recovery process, etc. – the reserves should be raised, or lowered, as needed. However, if the adjuster is raising the reserves to pay for this week's medical treatment, and raising the reserves next month to pay for the next doctor's visit, the adjuster is “stair-stepping the reserves." 

 
The difference between the adjuster who increases the reserves correctly and the adjuster stair-stepping the reserves is the number of reserve changes. A few well-reasoned and carefully thought out reserve changes is the proper way of making reserve changes.   Many small reserve changes without any thought as to the ultimate value of the claim is stair-stepping the reserves.
 
 
To avoid stai-stepping the reserves, the adjuster needs to know several things including:       
 
1.      the expected recovery time for the employee,
 
2.      the average weekly wage and the indemnity rate (as all indemnity calculations flow from these numbers)
 
3.      the ability of the employer to return the employee to work on modified duty or light duty while they recover from their injury
 
4.      the approximate cost of the medical procedures the employee will have for the type of injury incurred,
 
5.      the reputation of the medical provider for returning employees to work or keeping them off work
 
6.      the anticipated level of permanent disability the employee will have
 
7.      the cost of services for medical case management, legal, and other claim associated cost
 
8.      the requirements of the workers compensation statutes where the employee will receive benefits
 
 
The claims office will have either an electronic or paper reserve worksheet calculation page where the adjuster can fill in the calculations for each of these items to obtain an accurate projection of the future / ultimate cost of the claim. This will result in the accurate projected value of the claim and the correct amount of money for the adjuster to place in reserve for the claim.   When the adjuster skips the reserve worksheet calculation step, they often end up stair stepping the reserves. (WCxKit)
 
 
Stair stepping of reserves by adjusters should be avoided, and can easily be done by the utilization of the known information about the medical, indemnity and expenses for the individual claim. Proper reserving keeps the insurers financial balance sheet accurate, while stair stepping reserves understates the insurers liability.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

15 Benchmarks to Measure Claim Excellence by Workers Comp Adjusters

You have finally gotten the state-of-the-art claims management system. Now, that you have the ability to self measure your performance, are you doing so? The following benchmarks suggestions are some of the ways you can compare where you are now with where you were in the past. These benchmarks will also provide you with the information you need to objectively set goals for the New Year.

 

 

Many risk managers and claim managers want to measure their performance by the amount of dollars spent on claims. Financial results can be excellent benchmarks. We will discuss financial benchmarks, but also will look at ways to benchmark the quality of the claim handling process. Here are some benchmarks suggestions. (WCxKit)

 

 

Claim Financial Benchmarks

 

 

  1. Changes in average claim cost– This is the most common benchmark – a comparison of the average cost of medical benefits, indemnity benefits and claim expenses. The data is easily obtainable and allows you to compare your claim cost with last month, last quarter, last year and any other time frame you chose.
  2. Average claim cost compared to your industry– It is often not enough to know that your claim cost has declined since last year. You will also want to know if your claim cost is higher, lower or about the same as your business competitors. (A great way to gain a competitive edge in your industry is to do a better job of managing your workers’ compensation program). Information on your industry can often be difficult to obtain. Some of the large TPAs and large workers’ compensation insurers have partial data with which comparisons can be made. The National Council on Compensation Insurance (NCCI) collects payment data in the 35+/- states in which they operate, but they charge some hefty fees for their data on your industry.  WorkersCompKit has a good benchmarking system to quickly calculate these numbers.
  3. Initial reserve to ultimate value ratio– This is a ratio of the aggregate payments in a coverage line (for example: medical benefits) to the initial reserve value. This will give you an idea as to the knowledge and accuracy of the adjuster is estimating claim value.
  4. Ratio of reserves + payments (90 days prior to closing) to final claim cost– By comparing what the adjuster has in reserves plus claim payments made 90 days prior to the claim closing date, with the final amount paid on the claim, you can gauge the accuracy of your large claim reserving. [Exclude the claims closed in less than 6 months].   The ratio of reserves plus dollars previously paid on the claim, to the final claim cost should be approximately 1.0. If the ratio is under 1.0, the overall claims are under reserved. If the ratio is over 1.0, there is on average extra money setting in reserves.

 

 

Claim Handling Process Benchmarks

While there are many ways to gauge your claim handling, these are some suggestions for measuring claim-handling performance:

 

 

  1. Average bill process time– This is simply a comparison of days between the date the medical bill, legal services bill or other expense was received in the claims office, and the date the payment was processed. This allows you to measure the timeliness of your bill payment process and gauge the progress of your staff.
  2. Closing ratios– This is the ratio of files open during the month, quarter or year compared to the files closed during the same time frame.   Ideally 1.0 or better.
  3. Percentage of closed files with payments over $1,000– This indicator will keep the claim office honest on the closing ratios. It is too easy to manipulate closing ratios, so this will tell you the claim office close files prematurely when the number of closed claims with payments increase.
  4. Average time to input initial reserve – While different claim offices have different standards as to how soon (48 hours, 7 days, 15 days, 30 days) the initial reserve should be in the computer system, by comparing the current average length to time to a prior month, quarter or year, you can gauge how quickly the adjusters are inputting initial reserves.
  5. Average days between reserve changes– By having your computer compute the average number of days between reserve changes, you can quickly determine if the reserving is adequate. If you see on average a reserve change every 6 months, the claim office reserving procedure is probably okay. If you see the average days between reserve changes is 30 days, the claim office definitely has a problem with stair-stepping the reserves.
  6. Files on diary– This is a measurement of the files that are being actively worked on the diary. The claim office should have every file on diary to prevent the files from stagnating.
  7. Files with missed diary– This benchmark can be either a list of the files where the diary has not been updated the diary due date has passed, or it can be a percentage of the files with a claim handling due date that has passed. Either way, it provides you with insight into how current the claims office is in the handling of the claims.
  8. Claim file notes usage– As most computer systems automatically input a note when a check is paid, diary is due, etc., a benchmark measuring non-computer generated file notes will tell you how often on average each file is being actively reviewed/worked on by the adjuster.
  9. Initial index filings– If you require all your workers’ compensation indemnity claims to be indexed, this ratio will tell you whether your goal is being met. Your computer system should also be able to tell you the file numbers of the claims that have not been indexed so they can be corrected. (WCxKit)

10.Subsequent index filings – Many work comp insurers require long term claims to be re-indexed every 6 months or every year. This benchmark would compare the number of long term claims with the number of subsequent index filings.

 

 

Now while we can make these recommendation for benchmarks, don’t ask us to program your computer system. That’s a job for your IT department. However, by using these benchmarks, you can measure both the fluctuation in your claim financial and the success of your workers’ compensation claims handling program.

 

Grading you adjusters is another aspect of measuring adjuster performance. Ask the carrier or TPA whether they SCORE their adjusters – as in giving them a numeric grade. Broadspire scores and ranks their adjusters in a unique and extremely interesting scoring sytem which is backed up with additional training if needed. Adjusters with superior scores receive monetary incentives each month. This is the only such system I know about although there may be others.

 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  See www.LowerWC.com for more information. Contact:  RShafer@ReduceYourWorkersComp.com 

 

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.


©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact 
Info@ReduceYourWorkersComp.com.

 

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