If you self-administer your own claims, you already know hiring the best workers’ compensation adjuster(s) is a necessity. The challenge is in knowing what job skills and personal characteristics to look for in an adjuster beyond the normal experience and education job interview you may ask.
If you ask an adjuster candidate if s/he knows how to handle a work comp file, you will get an obvious answer like “I handled an open inventory of approximately 125 claims at any one time during my 5 years at XYZ Company.” The answer by the adjuster candidate assumes s/he was doing the job correctly, but is that true?
Before you interview adjuster candidates, take time to create a fictional test claim customized to the statutes within your state, with a partial investigation completed. The purpose of a “test claim” is to test the candidates’ technical competence and real knowledge of file handling.
Include in the fictional test claim information:
- the factsof the accident, with the supervisor’s name and the names of witnesses
- informationon the injury (make it a burn or a fractured limb with the need for surgical repair, or other complicated injury)
- the Employer’sFirst Report of an Accident form for your state (with wage information but no mention of the employee’s second part-time job)
- have facts(like horseplay or intoxication) that create questions in regards to compensability
- have facts(like sub-contractor or seasonal worker) that create questions in regards to coverage,
- the employeetreating at an unapproved medical provider
Following a review of the fictional claim by the candidate, ask the person:
- opinionas to coverage for the claim
- opinionas to compensability for the claim,
- to outlinethe investigation steps to take (interview the employee, the supervisor, and witnesses? contact the medical provider?)
- providea reserve calculation sheet showing how reserves will be set for the claim,
- showhis/her calculations of the average weekly wage
- list thestate forms needing to be filed, and when
- handlethe medical treatment at the unapproved medical provider
In your review of the adjuster candidate’s answers to the questions on the “test claim” determine if s/he missed any key points like coverage and compensability. Verify the investigative steps are correct, that s/he know how to properly establish the average weekly wage and to set reserves. Be sure the appropriate state forms would be filed and s/he knows and understands all state specific statutes. [If you are unsure as to the quality of the adjuster’s answers your claims manager or defense attorney can review the answers].
The personal characteristics of the workers’ comp adjuster candidate are very important. Being a workers’ comp adjuster is not easy. It takes a person with many personal characteristics beyond the job skills.
Personal characteristics include:
- Self-stress managementas the workers’ comp adjuster position can involve difficult people, deadlines, conflicting demands, pressure from both outside and inside the organization, and frequent change.
- Reasoningto understand relationships between facts, information from various sources and to data.
- Creative thinkingas the facts and issues vary from one claim to the next.
- Problem solvingability to analyze the facts and use proper reasoning to solve the problem when confronted with both relevant and irrelevant facts.
- Oral communicationability to obtain information from various sources and to convey information in a clear and precise manner.
- Written communication skillsto convey information in a well organized manner
- Interpersonal skills to deal with people who are injured, difficult, or even hostile.
- Self-motivationto set personal goals and to take the initiative to accomplish personal objectives and company goals.
- Honesty and integrityin all aspects of her interactions with everyone.
- People skillsincluding tactfulness, empathy, understanding, and concern.
- Planning abilityto set priorities, organize work, to achieve short term and long term goals.
- Customer service skillsto maintain rapport with employers and provide guidance and assistance to them.
- Self esteemto maintain a positive image of self and the company and to display it in a professional manner.
- Mathematical abilityin establishing indemnity benefits and reserves.
- Conscientiousabout the details of the work.
- Plays wellwith others and encourage cooperation, commitment, and company loyalty.
If you are unsure how to measure or evaluate the personal characteristics of the adjuster job candidate, there are various personality testing services and forms available.
The list of technical job skills and personal characteristics could be extended several more pages for the selection of the best adjuster candidate for your self-administered claims program. The skills and characteristics outlined here will assist you in weeding out unqualified or inappropriate adjuster job candidates. While testing of the technical competency and personal characteristics of the adjuster candidates takes more time and expense, it is well worth the investment of your goal in hiring the best qualified adjuster.
Author Rebecca Shafer, J.D., Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, manufacturing, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. 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.
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