How To Make Your Workers Comp Claim Adjusters Dream Come True

Workers compensation claims adjusters run into all kinds of different accounts– from large to small; from the manufacturing field to the professional field; from the safe to the unsafe, and everything in between. Maybe there is no such thing as the “perfect” workers comp account for the adjuster to handle, but there are many things adjusters look for including:

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“8 ‘Think Outside the Box’ Tactics to Settle Workers’ Comp Claims”

1. Their main contact is involved in the claim

Every claim warrants a call to the insured or client. Sometimes this call is more beneficial than others, based on the client. Some accounts have a dedicated workers comp contact, usually someone in the HR department, who can help with the gathering of facts on the claim. However, this person may not always have all of the information the adjuster needs.{WCx]

The perfect account will have a dedicated person who knows ahead of time what the adjuster needs and will readily share this information. This person knows to send the wage records and the personnel file, as well as knows about the injury details while having witness information and statements already taken. This contact knows what is needed, and knows not to put a personal “spin” on the details of the claim. This is all very helpful information for the adjuster, and it is something that the adjuster will request on every single claim that comes from that particular employer. The adjuster has one person to deal with while eliminating the need for countless phone calls to people at the employer who are all equally unhelpful.

2. The contact responds timely

One thing that is sure to bother the adjuster is leaving messages and sending emails with no response from the employer. Face it; the adjuster is not making the effort to contact the employer just for fun. The employer holds very key information needed to make a compensability decision on the claim.

The perfect workers comp contact for the employer responds on the same day, preferably within the same hour as the adjuster left a message or sent an email. This helps the adjuster move forward on the claim, since typically the first phone call the adjuster makes is to the employer for accident details before the employee is called.

3. The employer has a dedicated medical clinic that treats injured employees.

Too often employers allow injured workers to run to their own doctor, which will complicate the claim right away. The employee really does not know any better and just wants to get treatment for their injury. It will automatically create an air of mistrust if the injured worker goes to a personal doctor, and then the employer or adjuster forces them to go to the occupational clinic. Right away the employee will also adopt the “me versus them” attitude which does not help the claim.

4. The medical clinic knows the employer, and knows there are light duty work options available.

All too frequently, doctors are quick to place people out of work since they believe the only work available is the job they were doing at the time of the injury. It is very common, especially early on in a claim, that injured workers cannot perform all of those job tasks. This creates lost wage exposure and increases the overall cost on the claim.

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The perfect clinic knows the employer has light duty work options and will list medical restrictions that are useful to the employer and the adjuster. The doctor details lifting restrictions, and durations, and is quick to schedule a follow-up within 7days from the first appointment. Adjusters hate it when a doctor puts a person on a monthly follow-up appointment regimen since that means four weeks will go by before work restrictions or an “off work” status is changed or updated. The more the clinic physician knows about the employer, the more helpful it is for both employer and adjuster.

5. The employer is involved just enough to be helpful

Adjusters love to count on an employer to help provide information. But, too much information may not be helpful to the claim. Just because the employer has tons of information does not mean that it helps the adjuster. The informed employer has to know what to provide, what to elaborate on, and what not to provide. The same is true with employers who do not provide enough information. Some adjusters might prefer to have more information versus not enough, but the employer has to know where to draw the line. Adjusters do not need to know about certain industry issues, or what competitors are doing, or how past carriers used to handle claims. The perfect account provides the perfect information. This can be established by meeting the adjusting team and going over what is and is not needed. In the end it saves all parties time and makes everyone more efficient. [WCx]

Summary

There may not be any such thing as the “perfect” workers comp account. However, if employers and adjusters work together knowing what information is needed and take the time to create personal interest in all of the claims, the whole process runs a lot smoother and is more efficient.

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].

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

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.

FREE DOWNLOAD: “8 ‘Think Outside the Box’ Tactics to Settle Workers’ Comp Claims”