Claims are going up. Not just workers’ comp claims, but all claims, including valid claims and invalid or fraudulent claims.
“Suspected fraudulent claims related to workers’ compensation insurance were up 7%.”(1) Some workers are filing claims after or pending employer layoffs they did not filed at the time of the injury. These are often valid claims but were not filed perhaps because the worker was worried about the effect it would have on the employer, or chose to continue working rather than recuperate while receiving workers’ comp benefits. On the other hand, once a worker is laid off, workers’ comp benefits are better than unemployment benefits or no income at all. Many of these claims may be valid claims but may not have been filed under different economic conditions.
Adjusters have a higher number of cases because insurance companies have downsized. Not only do adjusters have a heavier case-load but 40% of their time is spent on administrative duties, required by workers’ comp regulations, unrelated to the business of helping move cases towards closure.
In a recent interview, John A. Mastropietro said “Insurance companies have downsized in recent years enormously, thereby leaving fewer claims adjusters, who are now handling a greater volume of cases. So there’s a tendency to not move on the part of those making decisions.”(2)
Cases are taking longer because the insurers are trying to cut costs wherever possible, and are taking a harder look at their workers’ comp claims. This also slows the process, because cases usually moving right along are being fought on both sides. More claimants and a more rigorous review process instituted by insurers, means more work per case with fewer adjusters to do the work.
Lastly, the economy is causing the extension of cases due to the perception that no jobs are available. Often labor market surveys are conducted showing there are no jobs available for the injured worker or claimant. So, an expensive and previously useful tool available to the case managers and claims adjusters backfires. It is true jobs are more difficult to come by. Why?
Companies are cutting their human resource departments and their advertising budgets, including “open position” advertising. Obviously, the cost of the ads is removed from the budget.
Another reason human resource departments are not advertising is due to the overwhelming size of the applicant pool. Any job posted online from executive to laborer is bound to receive hundreds if not thousands of applicants. This creates a situation very similar to the adjuster’s; more work is created while the staff has been downsized – and a situation referred to as “Paralysis through Analysis” results. (workersxzcompxzkit)
Too much paperwork and forms for each applicant results in continuous delays in filling the position. Therefore, many human resource managers are looking for alternative ways to locate the proper fit for their open positions. Personal relationships and peer or other “networks” are often the key to landing an appropriate position in any field. 1. NICB: Data Links Fraudulent Claims to Poor Economy 2. Poor economy doubles workers’ comp claims The Future of Workers’ Comp Claim Adjudication
Author: Katrina Paglierani of National Job Finders finds jobs for injured employees, performing job searches for injured workers’ with permanent restrictions to locate REAL jobs. National Job Finders sets up the interviews, notifies all parties, and follows up with their human resource contacts at the prospective employers. Contact at: Katrina@NationalJobFinders.com or 1-800-225-4070. “FRAUD PREVENTION” PODCAST click here: http://www.workerscompkit.com/gallagher/mp3 By: Private investigator with 25 years experience.
WC Books: http://www.reduceyourworkerscomp.com/workers-comp-books-manuals.php TD Calculator: www.ReduceYourWorkersComp.com/transitional-duty-cost-calculator.php WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker about workers’ comp issues. ©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@WorkersCompKit.com