Are you nervous talking to your workers compensation adjuster? Don’t be. The adjuster works for the insurer (whether the adjuster is a staff adjuster working directly for the insurer, or the adjuster works for a third party administrator (TPA) who is handling the workers comp claims for the insurer) and the insurer wants you to be happy with the claim service. The adjuster knows that ultimately your happiness with the quality of the his/her claim handling is key to the continuation of your company’s insurance with the insurer.
While the smart adjuster wants you to be happy with the work product, the adjuster also realizes he/she is the claims professional and it is the adjuster’s responsibility to direct and control the claim. WCxKit. The sharp adjuster welcomes your input and the information you provide while continuing to manage the claim.
To create a strong working relationship with the dedicated adjuster (an adjuster whose entire workers comp claim inventory is for your company) or the designated adjuster (an adjuster who handles all of your company’s workers comp claims plus claims for other employers), please keep in mind some basic guidelines.
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Establish Rapport
Whether you are working with a dedicated adjuster or a designated adjuster, having rapport with the adjuster goes a long ways toward having a good working relationship. Rapport is more than asking about the weather at the start of your conversation. It is knowing your adjuster and something about him/her other than work, whether WCxKit it is asking about vacation or the his/her child’s school program. By showing an interest in the adjuster as a person, you build a bond designed to make difficult issues easier to discuss.
Be Focused
After a minute or two of establishing rapport with the adjuster, be ready to address the claim you are calling about. Prior to calling the adjuster, review your file notes on the claim in question. It will be helpful to you to jot down the questions you want to ask the adjuster about the claim and the reasons for asking. Knowing your reason for asking each question allows the adjuster to provide a focused answer. Without an explanation, the adjuster will draw his/her own conclusions and may unknowingly give you an answer not fully covering what you need to know.
Be Respectful
It is always wise to remember the workers comp adjuster is the claims professional. The adjuster should be current in the handling of the claim and handling the claim in accordance to the Best Practices that are included in your service contract with the insurer or TPA. If for some reason the adjuster has not handled the claim correctly (in your opinion), don’t berate the adjuster or question the adjuster’s competence WCxKit. (if you want any more work done on your claims). You need to learn why the adjuster has not acted and to get the adjuster back on track. The easiest way to do this is to ask questions.
Ask Open Ended Questions
The best way to ask questions is to ask open-ended questions allowing the adjuster to explain what was done, what was not done and what is planned for the future. If you ask only yes or no questions, you get yes or no answers, making the adjuster feel like your questions are an interrogation.
For instance, it is much better to ask: “I don’t understand how this accident happened, how did [insert employee name] describe what happened?” rather than to say “You failed to take the employee’s recorded statement?” The first approach gives the adjuster the opportunity to say “I have tried several times to reach the employee, but he has not returned any of my phone calls.” The second approach, however, puts the adjuster on the defensive and reduces the desire of the adjuster to do a good job for you.
By asking open-ended questions, you give the adjuster the opportunity to explain the status of the claim and the course of action the adjuster plans to take. If for some reason the adjuster is not volunteering the information you need, explain why you are asking followed by an open-ended question. For example “Nobody saw this accident happen, what can we do to be sure it is compensable?”
Have a Positive Attitude
Always remember the adjuster is working for you and wants to do a good job. Be positive in your approach with the adjuster in both your words and tone of voice. When the adjuster has met your expectations, praise “it sounds like you are doing a good job” and appreciation “thanks for your efforts on this claim” It will motivate the adjuster to continue to strive to do a good job for you and your company.
Be Willing to Listen
Sometimes the efforts of the adjuster just come up short. As you ask about any “failure,” giving your reasons and asking your open-ended questions, listen carefully to what the adjuster says. Often the adjuster has a valid reason activities have not been accomplished or the claim is not going the way you wish. By carefully listening to the adjuster, you will often be able to identify problems and suggest solutions to assist the adjuster in producing a better quality claim product.
Cooperate and Plan
After you have discussed all the questions you have about a workers comp claim, and have a complete understanding of where the claims currently stands, plan your further activity on the claim. Ask the open-ended questions “So I will know when to follow up with you, what is your plan to move the file forward?” “When do you expect to accomplish your action plan?” “Who else do we need to keep in the loop and how will that be done?”
Summary
Talking to your workers comp adjuster should be a pleasant experience providing you with the claim information you need for your company. This can be easily accomplished by establishing rapport with the adjuster, keeping focused on the claim you are inquiring about and remembering the adjuster is the claims professional. The easy way to obtain information is to state why you are asking a question and then asking an open-ended question allowing the adjuster to explain the claim to you. Always keep a positive attitude with the adjuster and listen carefully to what the adjuster is saying about the claim. This will allow you to work with the adjuster to bring the claim to a conclusion.
Author Rebecca Shafer, Consultant / Attorney, 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: [email protected] 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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