If you have ever wondered what your workers comp adjuster does in a day, please read this fictional, but true-to-life account of an adjuster’s typical day. Let’s take a look at what a typical adjuster does during the day and reflect on how we can help him/her help us better manager our programs. Although this blog refers to workers compensation adjusters, the work day of others is probably about the same. One noted exception is a “field adjuster” who may work on the road, for example, in auto claims.
Most adjusters who have been on the job for a realize their workload will always be greater than they can ever attend to properly. This won’t stop most of them from trying to cover everything that needs to be done. It is not unusual for the dedicated adjuster to arrive at the claims office early and be one of the last employees to leave at night.
It is usually the workers comp adjuster who arrives first at the office and makes a pot of coffee for herself (or himself) and her co-workers. After a few sips of coffee, the adjuster turns on her computer and brings up her diary (her computer calendar) of all the claims she needs to work on during this day. However, before she starts to work on any of her claims, she turns to the telephone and retrieves all her voice mails from claimants (employees), employers, medical providers, attorneys, nurse case managers, her supervisor, various vendors and others who have called her about her claims.
The adjuster than compares her voice mail messages with her diary to see where she can combine the diary and voice mail to save time on the files. After she combines the diary and the voice mails, she prioritizes the claims and creates her work agenda in the order of importance.
During her workday, the workers comp adjuster has frequent and sometimes complex contacts with many parties. For the next couple of hours the adjuster will be on the telephone contacting employers, employees and medical providers to obtain additional information about the progress or status of the claims.
If the adjuster is good at multitasking, she will be entering file notes on each claim as she is talking to each person. If she is not comfortable with multitasking, she will write up her files notes immediately following each phone call and before she starts the next phone call.
By the time the adjuster is done with her phone calls for the morning, the daily mail should have arrived at her desk (or have been scanned into the computer system). The adjuster then turns to reviewing each item of correspondence and entering her file notes on each medical report, attorney’s letter, etc.
The adjuster never get through her morning phone calls that she makes and the daily mail without receiving additional phone calls from people. Depending on the claim office philosophy or the adjuster’s preference, the adjuster will stop working on the incoming mail and take the phone calls as they arrive, or allow them to start accumulating again in her voice mail.
It is an old claims office adage – “Your interruptions will get interrupted.” The adjuster must decide for herself if she is more proficient by taking each phone call as it arrives, or by grouping them and returning the phone calls once in the morning and once in the afternoon.
Between telephone calls and correspondence, the adjuster’s morning is packed with other things to do.
If the supervisor has assigned a new workers comp claim to her, she must put on hold all the items on her agenda and make her three-point contacts with the employer, employee and medical provider. If she has a worker’s comp board hearing, she may have to leave everything and attend the hearing. If she has a settlement conference, she may attend the settlement conference in person, or by telephone. If she has a crisis of some type on any of her files, she will stop work on her daily agenda and deal with the crisis. Our third party-administrators and insurance companies have many adjusters who are the primary contact for many of us in the workers’ compensation field.
After a quick lunch, often eaten at her desk in order to save time, the workers comp adjuster starts her afternoon round of phone calls, mail review, outgoing correspondence and file reviews. In the middle of all these activities, the adjuster will often take time out to discuss complicate claim issues with other adjusters or to provide mentoring to inexperienced adjusters. Over the cubicle wall discussions of claims and procedures will occur throughout the afternoon as she assists other adjusters with their claims.
Every day the adjuster is interpreting and applying the workers comp statutes, the insurance policy coverage and her employer’s work policies and procedures. The exercising of judgment and initiatives is a routine part of the adjuster’s daily task. The adjuster not only makes many decisions during the day, but also has to communicate effectively those decisions both verbally and in written communications.
In the states with complicated state forms to file on every claim, the adjuster will often set aside a specific time each day to be sure the state mandated forms are completed and filed either electronically or by mail as required within her state.
By the time the adjuster turns out the office lights at night, she will have had an impact on the lives of several claimants as she has assisted them in obtaining the medical and indemnity benefits they are owed. She will have also had an impact on the insurer as she has provided the benefits the employee is entitled to while protecting the assets of the insurer from being overspent. It’s not easy being a workers comp adjuster but it is often a satisfying and fulfilling job.
Author Rebecca Shafer, J.D., Consultant, President, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers’ Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
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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.
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