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

Before Header

  • About
  • Contact
  • Privacy
 
Paradigm

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login

Mobile Menu

  • Home
    • Training Center
  • Search
    • Free Resources & Solutions
    • Subscribe to Free Newsletter
    • Create Free Training Center Account
    • Enroll in On-Demand Courses
    • Activate WC Mastery Membership
    • Request Strategic Coaching Session
    • Buy WC Guidebooks
  • Membership
    • Insider (free account)
    • WC Mastery
    • Teams & Managers Mastery
    • Training Partners
  • Products
    • On-Demand Courses
    • Specialty Courses
    • Certifications & Mastery Courses
    • Ultimate Guidebooks
    • Coaching
  • Blog
    • Video Blogs
    • COVID-19 / Coronavirus Pandemic
  • Login
  • About
  • Contact
  • Privacy
You are here: Home / Claim Management / Claims Adjuster & Employer Relationship / Six Things that Drive Workers Compensation Adjusters Crazy

Six Things that Drive Workers Compensation Adjusters Crazy

March 12, 2019 By //  by Rebecca Shafer, J.D.

workers compensation adjuster Being a workers’ compensation adjuster has a lot of demands. Every day you have to juggle multiple demands on many files, sometimes within several jurisdictions. A typical caseload for the lost-time adjuster is 150 active files. The adjuster tries to handle the demands of those files in addition to the phone calls, emails, and medical records, usually without any support staff.

Every workers’ compensation adjuster appreciates anything that helps make their job easier. Below we discuss six small items that can make a big difference to Joe (or Josephine) Claims Adjuster.

Click Link to Access Free PDF Download

“How Do I Get My Adjusters To Follow My Account Handling Instructions?”

1. Please complete all fields on the injury form.

When an workers’ compensation adjuster first gets a new assignment, nothing makes them more frustrated than to see many fields missing information. This can include social security numbers, birth dates, the type of injury, the date the injury was reported to the supervisor, etc. All of these fields are equally important, and when any are empty it means another phone call to the contact at the insured to gather this information. Take the time to complete all fields, so the adjuster has the information needed to get started on the file investigation without delay.

NOTE TO EMPLOYERS: IF YOU LEAVE BLANK FIELDS, SOMEONE ELSE MAY FILL THEM IN – WITH ANSWERS THAT YOU WON’T LIKE. Attach information if there isn’t enough room for the complete answer. Staple it and mail a copy to the adjuster.

2. Report All Claims in a Timely Manner.

The next thing that annoys workers’ compensation adjusters are late claims. Depending on the jurisdiction, this can put the adjuster in a time crunch to gather as much claims information to complete the investigation, and the fact they are rushing can lead to errors, or even worse, leakage. The last thing anyone wants is money and time wasted on a claim that is not compensable. One of the best things you can do is to report a claim right away. Do not let it sit on your desk until the injured worker goes in for surgery the next day. The sooner you can get that injury report to your adjuster, the better chance they will have to do a proper, thorough investigation. This leads to correct, ethical decisions on your claims without delays, penalties, or leakage.

3. Let the adjuster know if there is lost time on a claim.

Claims that include lost wages carry a certain priority with the workers’ compensation adjuster, since every day that clicks by means another day of potential wage loss due to the employee. As mentioned above, injuries should be reported right away. This gives the adjuster time to gather medical records to see if the claim is compensable. It also gives the adjuster a chance to get work restrictions on your employee so they can be placed in your light-duty work program. This eliminates the need for lost wages paid to the employee and keeps your claim costs down. When injuries are reported right away, everyone wins. The employee gets prompt contact by the adjuster, the adjuster gets a jump on the claim, and the employer gets to keep their costs down as low as possible.

4. Don’t tell the adjuster if a claim is compensable or not. It bugs them.

As much as you think a claim is legit or not, the employer typically cannot make a decision on a claim’s compensability. This is the adjuster’s job — what they get paid to do. This is why they are licensed to be claims adjusters in your state. They have the training and certification to make the decision on compensability. It is really important to voice your opinion on the claim, and to be able to back up your assumptions with facts. This will greatly help the adjuster with their investigation, but the overall decision on if the claim is accepted or not should be left up to the adjuster. Plus some jurisdictions have steep fines if claims are denied in error, so why put yourself in that position? Leave it up to the claims professionals.

IF IT IS NOT A LEGITIMATE CLAIM – TELL THEM YOU SUSPECT FRAUD. PUSH IT- so you are taken seriously. I don’t always live by my own advice here, and I almost always give my opinion about what I think is compensable, or not…

FREE DOWNLOAD: “How Do I Get My Adjusters To Follow My Account Handling Instructions?”

5. Make yourself accessible to the adjuster and return calls as soon as possible.

Workers’ Compensation adjusters have to make many phone calls every day. They are constantly on the phone. If they are calling you to get facts on an injury, and they leave you a message to call them, please call them back as soon as you can. Employer input on claims is important. Bear in mind you see your employees every day. You know a lot about them that the claim adjusters do not. Your investigation is just as important to the adjuster as is theirs. They rely on you heavily to know about the injury, what happened, why it happened, and what happened after the worker left. Send them any medical information you have, as this also will give them the provider’s name, address, contact info, and initial diagnosis. If you get bills for the treatment from the provider send them to the adjuster so they can be processed for payment if the claim is compensable. Anything you get that involves the claim should be sent to the adjuster, no matter what it is. The adjuster would always rather have more information than not enough.

6. Know the details of the injury soon after it happened.

The first question the workers’ compensation adjuster will ask you when they call is, “What happened?” Adjusters hate to hear the answer, “I do not know.” Obviously, this does not help the adjuster. You should be heavily involved in any claim that occurs at your workplace, whether it is a work comp injury, a liability injury, or a property damage claim. Gather facts and witness statements to send to the adjuster. Comments the witnesses have can impact a claim because the adjuster will compare that to the history given to them by the injured worker, and what history the injured worker gave the doctor when they were first examined in a medical facility. Any facts that do not add up will raise the red flag that there may be something more to this claim than what is on the surface, and it could prevent a claim from being falsely accepted. This again will keep your costs down, since you will not incur the leakage associated with paying a claim in error.

Conclusion

In conclusion, these are 6 items that can greatly help the workers’ compensation adjuster, even though you as the employer may find them quite trivial. You would be surprised if you saw the amount of information adjusters have to process on their 150-200 claims each day. Every little bit of information to the adjuster helps them out and makes their job easier. It all leads to the same goal that we have in claims, which is to properly investigate every one so the appropriate decision can be made on the compensability.

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:.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

©2019 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “How Do I Get My Adjusters To Follow My Account Handling Instructions?”

Filed Under: Claims Adjuster & Employer Relationship Tagged With: Popular Workers' Compensation Articles

Related Articles

Expecting the Unexpected in Work Comp – Part 2

Expecting the Unexpected in Work Comp – Part 2

Expecting the Unexpected in Work Comp

Expecting the Unexpected in Work Comp

Pick The Right Adjuster For The Right Workers Comp Claim

Pick The Right Adjuster For The Right Workers Comp Claim

5 Steps When Favorite Employee’s Workers Comp Claim Is Denied

5 Steps When Favorite Employee’s Workers Comp Claim Is Denied

Dedicated Adjuster Is Key Team Member To Cut Work Comp Costs

Dedicated Adjuster Is Key Team Member To Cut Work Comp Costs

Give Your Work Comp Adjuster A Hand To Achieve Better Outcomes

Give Your Work Comp Adjuster A Hand To Achieve Better Outcomes

Have All The Right Information Before Changing Your TPA

Have All The Right Information Before Changing Your TPA

6 Ways To Maximize Your Work Comp Adjuster Relationship

6 Ways To Maximize Your Work Comp Adjuster Relationship

20 Unfair Claim Practices For Your Adjuster To Avoid

20 Unfair Claim Practices For Your Adjuster To Avoid
5 Workers’ Comp Communication Strategies to Ramp Up Your Program

Successfully Communicate With Your Work Comp Claims Adjuster

Successfully Communicate With Your Work Comp Claims Adjuster

5 Ways to Get the Most Out of Your Workers’ Comp Adjuster

5 Ways to Get the Most Out of Your Workers’ Comp Adjuster

18 Items in Your Work Comp Adjuster’s Three-Point Contact

18 Items in Your Work Comp Adjuster’s Three-Point Contact

Free Download

How Do I Get My Adjusters To Follow My Account Handling Instructions? - 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: « 21st Century Skepticism in Science and Effects on Medical Care
Next Post: The Dangers of Under-Reserving »

Primary Sidebar

FREE DOWNLOAD

How Do I Get My Adjusters To Follow My Account Handling Instructions? - FREE Download Click Here Now!

Our Sponsors

ARCADIA - Enhancing Settlement Outcomes

The Structured Settlements Company
 

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

MSAs, Section 111 Audits, & Conditional Payment Resolutions
 

Post-Settlement Administration
 

Medcor

Injury Triage, Onsite Clinics

Read Our Award-Winning Blog

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 2500 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

  • Effective Communication Skills in Work Comp
  • Paradigm Announces Acquisition of Welvie
  • 3 Quick Fixes to Stop Out of Control Workers’ Comp Costs
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 © 2023 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice