“What should I do if the adjuster doesn’t return your call or reply to your emails?” This is a common issue for adjusters with a high case load. Here are a few suggestions:
1- Discuss the issue with the adjuster – It’s best to start by simply asking the adjuster why they have not been responding. It may be a simple issue that can be fixed easily. Hopefully, you will bring this to their attention – that you appreciate a reply – and they will make that a priority in the future. If the adjuster continues to be unresponsive, however, make sure to take notes of when you have left messages and sent emails and when the adjuster has responded. As a general rule, once it’s to the stage that you are keeping notes, it’s time to bring it to the attention of your broker.
2- Discuss the issue with the broker and/or claims consultant – If the situation is not fixed by discussing it with the adjuster, you will need to escalate it to getting your account executive or claims consultant involved. Don’t wait very long to do this. Certainly one missed email is not enough to raise it to the next level, but 5 or 6 would be enough. Any time there is a pattern of not returning phone calls, this should be brought to the broker’s attention.
3- Keep your Account Executive at the broker in the loop – You should have a relationship with your broker or the claims consultant (employed by the broker) — either or both, depending on your needs. Make sure you copy him/her on all correspondence. Initially, you can “blind copy” them during the stage in which you are trying to work out the situation one-on-one with the adjuster. If the problem continues, copy the broker or claims consultant. Sometimes when the adjuster sees that another party has been copied on the emails will be enough for them to begin replying.
4- The Claims Consultant will take action –Almost always, the claims consultant will contact the adjuster’s supervisor to attempt to get to the bottom of the problem Let the claims consultant be the “bad guy” while you try to stay above the fray. The claims consultant will attempt to determine the problem. Perhaps the adjuster has too many claims for their experience level, not enough support staff, an illness that’s keeping him/her out of work and no replacement while out of work. When an adjuster is out of work and doesn’t have a replacement, they may have returned to 300-400 emails or more. In most situations, emails “roll” to staff that is covering in the absence of the adjuster. The claims consultant may ask that a temporary adjuster be hired to assist the regular adjusters. He/She may schedule an audit to determine whether the unresponsiveness is leading to other problems with claims handling.
5- If the situation is not resolved, a meeting between the parties will be necessary – All parties will be involved and the goal is to develop a way to resolve the problem, a timetable to do so and options if the situation is not corrected. For more cost savings tips go to WC Cost Reduction Tips. Show the REAL cost of workers comp with the Real Cost Calculator.
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
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