• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Search
  • Resources
  • Privacy
  • Contact
 

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising

Mobile Menu

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising
  • About
  • Search
  • Resources
  • Privacy
  • Contact
You are here: Home / Buyers Guide: Workers Compensation Insurance / Broker Issues & Relationships / 8 Ways to Grade Your Workers Compensation Claim Adjuster

8 Ways to Grade Your Workers Compensation Claim Adjuster

June 16, 2011 By //  by Rebecca Shafer, J.D. Leave a Comment

Often it is assumed the designated adjuster(s) working on your workers compensation files is a good adjuster. But, you know what “they” say about “assuming.” Use these eight tips to judge your adjuster(s) overall ability and effectiveness.

Click Link to Access Free PDF Download

“How to Calculate Your Minimum Experience Mod, Controllable Premium & the Revenue Impact”

1. Timely Contact with All Parties

Track how often the adjuster makes timely contacts. If your Best Practices say claimants, medical providers, and the employee’s supervisor must be contacted within 24 hours of the first report of an accident, expect your adjuster to be making timely contacts with all parties at least 90% of the time. The higher the percentage, the better. Timely initial contacts go a long ways toward establishing the future tone of your claims and establish the adjuster as the person in charge.

2. The Accuracy of Reserves

When you look at your loss run and compare what the claim settled for against the claim reserves you gain insight into the ability of the adjuster to evaluate the claim. If you see a lot of reserve changes right before the claim settles, then the adjuster is either inexperienced at evaluating the claim or is indifferent to the impact reserves have on your company. If you see the reserves on the claim were established since the adjuster obtained key medical information on the injured employee, you know the adjuster is looking out for your financial interests.

3. Responsiveness

Does the adjuster always answer the phone when you call, or do you often have to leave messages and wait a few days to hear back? When you send e-mails, do you get a prompt response, or do you forget what the subject of the e-mail was by the time the adjuster responds? A good adjuster tries to keep you informed about your claims and takes the time to respond to your questions and needs. The quicker the response from the adjuster, the better the adjuster.

4. Payments Timely

If your employee complains the TTD or TPD check did not arrive on time, then the adjuster is not organized (or may have too many claims to handle properly). You should expect never to hear from an employee about the indemnity check not arriving. If your employees are receiving dunning notices from their doctors on medical bills, then the adjuster is not processing the bills timely. While any adjuster may occasionally have a medical bill or other missed expense, you or your employees should not be constantly getting reminders on medical bills.

5. The Number of Employees Lost to Attorneys

The good adjuster stays in contact with employees out on workers comp. The great adjuster builds rapport with the employees and the employees make an effort to keep their adjuster informed as to their medical progress and their ability to return to work. The poor adjuster has a higher percentage of employees represented by an attorney then the good adjuster. As the percentage of employees represented by attorneys is impacted by the legal climate in your locale, you must consider the results of your adjuster compared to other adjusters in the same locale.

FREE DOWNLOAD: “How to Calculate Your Minimum Experience Mod, Controllable Premium & the Revenue Impact”

6. Knowledge of Workers Compensation

When you have a question about workers comp in general, the good adjuster can answer it for you, (or at least get you the answer). If the adjuster does not know the answer, or tells you it would be better for you to talk to a workers comp attorney or the adjuster’s supervisor, the adjuster’s workers comp knowledge is weaker than it should be. The good adjuster knows all the ins and outs of state statutes and is willing to share that information with the employer.

7. Claim Quality Audit Scores

Often claim offices do not want to talk about their claim quality audit scores. This often arises out of a concern that the employer may not understand that the 100% perfect claim file seldom happens. However, the good workers comp adjuster scores in the 90+ percentile. Ask the adjuster for a copy of the most recent audit score. The good adjuster is glad to share it with you. The weak adjuster probably has reasons why it cannot be shared.

8. Closed Files Reopened

Every adjuster knows the best file is the closed file. However, it is seldom a good idea to close a file prematurely. The good adjuster makes sure all aspects of the claim are resolved, all medical bill paid, all indemnity checks issued, and all expenses paid before closing the file. If you see more than a few reopened files on the loss run report, than the adjuster is closing claims prematurely.
None of these 8 criteria alone indicate a good or poor adjuster. When the adjuster is strong in all 8 areas, you have a great adjuster working your claims. If the adjuster is weak in most of these areas, it is time to consider requesting another adjuster to handle your workers comp claims. Having a strong adjuster on your claim files makes your life easier and saves money. A few select TPA’s DO actually “grade” their adjusters, giving monthly bonuses to those that excel, and get high grades – nearing 100.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
Our WC Manual: http://corner.advisen.com/partners_wctoolkit_book.html
WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR: http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter
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.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com

FREE DOWNLOAD: “How to Calculate Your Minimum Experience Mod, Controllable Premium & the Revenue Impact”

Filed Under: Broker Issues & Relationships Tagged With: Adjuster Qualifications & Responsibilities, Choosing an Adjuster, Working with Your Adjuster

Related Articles

Key Questions to Ask When Selecting An Insurance Broker

Key Questions to Ask When Selecting An Insurance Broker

Unethical Carrier Behavior? When To Run For The Hills…

Unethical Carrier Behavior? When To Run For The Hills…

The Workers Comp Insurance Broker – Employer Relationship

The Workers Comp Insurance Broker – Employer Relationship

Three Areas to Review for 2013 Workers Comp Preparation

Three Areas to Review for 2013 Workers Comp Preparation

Industry Leaders Discuss Challenges at Broadspires First Pharmacy Summit

Industry Leaders Discuss Challenges at Broadspires First Pharmacy Summit

Understanding Key Differences Between Insurance Agents and Insurance Brokers

Understanding Key Differences Between Insurance Agents and Insurance Brokers

Fiduciary Responsibilities of the TPA

Fiduciary Responsibilities of the TPA

7 Things Brokers Wish Employers Knew

7 Things Brokers Wish Employers Knew

5 Things Your Broker Won’t Tell You About the Insurance Company

5 Things Your Broker Won’t Tell You About the Insurance Company

Anatomy of an Employer Dispute with Their Third-Party Administrator

Anatomy of an Employer Dispute with Their Third-Party Administrator

Insurance Companies Ordered to Return $9.4 Million in Excess Profits

Insurance Companies Ordered to Return $9.4 Million in Excess Profits

How to Choose a Great Workers Comp Insurance Agent for Small Businesses

How to Choose a Great Workers Comp Insurance Agent for Small Businesses

Free Download

How to Calculate Your Minimum Experience Mod, Controllable Premium & the Revenue Impact - FREE Download Click Here Now!

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Previous Post: « Scottish Safety and Health Forum to Be Held In Glasgow
Next Post: Dr. Alice Martinson on Loss Control and Musculoskeletal Injury Prevention »

Reader Interactions

Leave a Reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

FREE DOWNLOAD

How to Calculate Your Minimum Experience Mod, Controllable Premium & the Revenue Impact - FREE Download Click Here Now!

Our Sponsors

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Injury Management Solution for Employers

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 5,000 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Win Without the Fight: How Employers Can Prepare for Trial—And Avoid It Entirely
  • From Adversaries to Allies: Why Employers and Defense Attorneys Must Act Like a Team
  • Breaking the Cycle: How Fear Drives Workers’ Comp Litigation—and What to Do About It
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2025 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice