If you ask an adjuster candidate if s/he knows how to handle a work comp file, you will get an obvious answer like “I handled an open inventory of approximately 125 claims at any one time during my 5 years at XYZ Company.” The answer by the adjuster candidate assumes s/he was doing the job correctly, but is that true?
Before you interview adjuster candidates, take time to create a fictional test claim customized to the statutes within your state, with a partial investigation completed. The purpose of a “test claim” is to test the candidates’ technical competence and real knowledge of file handling.
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Include in the fictional test claim information:
- facts of the accident, with the supervisor’s name and the names of witnesses
- information on the injury (make it a burn or a fractured limb with the need for surgical repair, or another complicated injury)
- Employer’s First Report of an Accident form for your state (with wage information but no mention of the employee’s second part-time job)
- have facts (like horseplay or intoxication) that create questions regarding compensability
- have facts (like sub-contractor or seasonal worker) that create questions regarding coverage,
- employee treating at an unapproved medical provider
Following a review of the fictional claim by the candidate, ask the person:
- opinion as to coverage for the claim
- opinion as to compensability for the claim,
- to outline the investigation steps to take (interview the employee, the supervisor, and witnesses? contact the medical provider?)
- provide a reserve calculation sheet showing how reserves will be set for the claim,
- show his/her calculations of the average weekly wage
- list the state forms needing to be filed, and when
- handle the medical treatment at the unapproved medical provider
In your review of the adjuster candidate’s answers to the questions on the “test claim” determine if s/he missed any key points like coverage and compensability. Verify the investigative steps are correct, that s/he know how to establish the average weekly wage properly and to set reserves. Be sure the appropriate state forms would be filed and s/he knows and understands all state-specific statutes. [If you are unsure as to the quality of the adjuster’s answers your claims manager or defense attorney can review the answers].
PERSONAL CHARACTERISTICS
The personal characteristics of the workers’ comp adjuster candidate are very important. Being a workers’ comp adjuster is not easy. It takes a person with many personal characteristics beyond the job skills.
Personal characteristics include:
- Self-stress management as the workers’ comp adjuster position can involve difficult people, deadlines, conflicting demands, pressure from both outside and inside the organization, and frequent change.
- Reasoning to understand relationships between facts, information from various sources and to data.
- Creative thinking as the facts and issues vary from one claim to the next.
- Problem-solving ability to analyze the facts and use proper reasoning to solve the problem when confronted with both relevant and irrelevant facts.
- Oral communication ability to obtain information from various sources and to convey information in a clear and precise manner.
- Written communication skills to convey information in a well-organized manner
- Interpersonal skills to deal with people who are injured, difficult, or even hostile.
- Self-motivation to set personal goals and to take the initiative to accomplish personal objectives and company goals.
- Honesty and integrity in all aspects of her interactions with everyone.
- People skills including tactfulness, empathy, understanding, and concern.
- Planning ability to set priorities, organize work, to achieve short-term and long-term goals.
- Customer service skills to maintain rapport with employers and provide guidance and assistance to them.
- Self-esteem to maintain a positive image of self and the company and to display it professionally.
- Mathematical ability in establishing indemnity benefits and reserves.
- Conscientious about the details of the work.
- Plays well with others and encourage cooperation, commitment, and company loyalty.
If you are unsure how to measure or evaluate the personal characteristics of the adjuster job candidate, there are various personality testing services and forms available.
The list of technical job skills and personal characteristics could be extended several more pages for the selection of the best adjuster candidate for your self-administered claims program. The skills and characteristics outlined here will assist you in weeding out unqualified or inappropriate adjuster job candidates. While testing of the technical competency and personal characteristics of the adjuster candidates takes more time and expense, it is well worth the investment of your goal in hiring the best-qualified adjuster.
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 co-author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: [email protected].
Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
