Claim reserving is complex, complicated, and difficult. Just when a claims professional thinks they have got it down, a claimant has another failed back surgery and they are back to the drawing board.
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“How Do I Get My Adjusters To Follow My Account Handling Instructions?”
Adjuster Claim Reserving Tips:
1. Your initial investigation will be more important than you think.
Your employer contact will also yield clues that impact your reserving practice for this file. Can they accommodate light duty work? Are they willing to return this worker back as soon as possible, or do they wait a few weeks? Do they have other workers that can help your injured worker to complete tasks if some job duties fall outside of their restrictions? The answers to these questions all affect the indemnity portion on a work comp claim. If the employer refuses to put someone back to work until they are full duty, then you know you will need to place more indemnity reserves in this file than if the employer welcomed back the injured worker with open arms, willing to do whatever it took to get this person working again in any capacity.
2. Remember to address impairment ratings if applicable
3. Factor in Psychological/Sociological/Secondary Gain issues
4. Remember to utilize the resources around you if you have questions
Correctly reserving a file is a science. Even the most seasoned claims adjusters can fall victim to a runaway claim. Usually the best learning experience is to have a claim you are handling spiral out of control, worse than you could have imagined when you had first received notice of an injury. But there is help available, and you should not be shy about asking for help. You will find out that everyone is more than happy to assist you. All you have to do is ask.