Things Claimants Say That Make An Adjusters Eyes Roll

Always as a disclaimer, I feel it is right to warn that I am writing this from a claims adjuster point of view. And not the normal claims adjuster, but this particular article is written from the “annoyed claims adjuster” point of view.

In the light of a new year, I thought it might be time to start anew. When in this business for a long time, a lot of old habits die-hard. This is true with certain buzzwords and injury scenarios. Adjusters pretty much do the same job day in and day out. The injuries may be familiar, but the personality of the claimants can vary widely. Since spending a majority of the day on the phone, after a while even the most polite claims adjuster gets sick of talking on the phone. This can ring especially true when a claimant hits upon one of the buzzwords or scenarios listed below. Little more can make adjuster’s eyes roll faster than mentioning some of the words below. The same can be said for demanding outrageous services, such as household assistance or assistant care for a minor injury. But there are plenty of other things sure to annoy, so relax and enjoy my list of surefire ways to irritate the adjuster.

1. Saying “tore the rotator ‘cup’ ”

One of my personal favorites, nothing makes me laugh more than when claimants accidentally fudge a diagnosis. I understand that they are trying to talk “shop” with me but please do it correctly. I am not exactly sure where the rotator cup is, but my shrewd levels of problem solving can figure out that I think you mean rotator CUFF. Make a note of it.

2. “I slipped a disc”

Ah, another favorite. I have been to countless seminars about lower back pain and injury. I have probably handled hundreds of spinal injury cases, ranging from minor to severe, and from non-operative to operative. Is it true that a disc can protrude out and cause pain? Sure it can. In fact, the disc can herniate, tear, bulge, protrude, fragment, etc. I have yet to attend a seminar about a disc that “slips.” Where does it slip? Does it slip on the floor? Does it slip due to some magic force? I am not sure where this buzzword came from, but it will greatly annoy the claims adjuster for sure. And I wish it would go away.

3. “Workman’s comp”

The last time I checked my calendar, it was 2012. I am pretty sure that women in the workplace can get injured as well. So if a woman gets injured, it is “workwoman’s comp?” I think that any other word can offend less than workman’s comp. You can use worker comp, work comp, comp, work disability, as a matter of fact use anything instead of workman’s comp. Workman’s comp is a horribly dated term, and just plain annoying in general. FYI…. About 60% of people who search on the web use the term “workman” so it’s a common error and one which we know won’t go away anytime soon, although we can hope.

4. Claimants that state they know they should be paid a certain amount for wage loss and disagree with the correct calculation

Throughout the sands of time, I have discovered that there are a lot of people out there that know a lot more than I do. I never claimed to know every facet about everything. But if a claimant tries to challenge my ability to do my job, I hope they know what they are talking about. In almost all jurisdictions, what a claimant is paid in lost wages is governed by the State that which jurisdiction is deemed. If all I did was incorrectly pay people, especially by underpaying them, then why do I still have a job in this business? I know that people hear rumors and alleged facts from other people about what they got paid when they were hurt, but that does not make them a licensed adjuster that ultimately has to report to the State what wages were paid and how we arrived at that amount.

5. Trying to settle the claim for $1,000,000 or more

I like to get free money. In fact, I like it a lot. I like it more than working itself. As a negotiator, I feel satisfied if I can negotiate a lower car payment, or a lower interest rate on a credit card. I also see the same commercials on TV from Plaintiff law firms, which promise thousands upon thousands of dollars rewarded for the pain and suffering from injury. But that does not mean that the case is worth a million bucks. I hope that nobody is injured so badly that it would legitimately take over a million dollars to resolve their claim. If that were the case, there would not be the luxury of spending the million dollars, because the claimant is incapacitated both physically and medically. Try to be reasonable, and we can settle the claim. Also the claimant may be able to squeak out more than what I think the claim is worth. But the call is about a minor back injury and a demand of a million dollars to settle, call that plaintiff law firm and see if they can help get that amount from elsewhere.

6. The claimant reports being able to only lie on the couch all day immobilized

In addition to being a fan of free money, I daydream about the time in life when all I have to do is lay on the couch. Do not get me wrong; some injuries are bad enough to be immobilized. This is more targeted towards those people again with minor injuries who present it to be this major ordeal that has rendered the claimant totally disabled from doing anything, especially working.

7. Fibbing about not treating before for this type of injury

Injured workers fear that the claim may not be believed or accepted, so there is an attempt to try and protect the wage loss by saying this is the first time to have shoulder pain, or knee pain for example. Part of a normal investigation is asking if there are prior injuries or treatment for the injured body part. All the claimant has to do is be honest. If I play 27 holes of golf in one day, my back is sore. If I try and do too much while packing boxes or moving something I may strain myself enough to have to go to the doc and get a prescription or two. But at least I am honest about it. We are going to be obtaining all medical records that we can find about the claimant, and if we do stumble upon some prior medical history, this is not going to bode well. It is not necessarily going to derail the case, but it will definitely raise a red flag the claimant is hiding something, and I am going to keep on digging until I feel I have exhausted all my resources.

Summary

This article is meant to be lighthearted and fun, but there is a grain of truth to it as well. If you talk to anyone in this industry I think the common consensus will be the same. So all violators out there take note.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: [email protected].

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