A good insurance adjuster can help minimize the costs of a workers’ compensation claim. For your adjuster to do their best job for you, you must give to and get from them thorough information. You must completely document workers’ compensation claims, starting at the time of the injury. As your employee recovers or even worsens, you need to have every step in the process documented. Because a proactive adjuster will coordinate and manage the employee’s medical care and return to work, you need to maintain contact with the adjuster to check on the claim status of your employees’ comp cases.
Communication is Key
After your initial contact with the adjuster following the injury, you must periodically have follow up communication. A good adjuster is a good communicator that documents all contact. Open communication allows for the exchange of information between the employer and adjuster about the claim and ideas on assisting the injured employee while moving the claim forward. The best adjusters completely document each phone call, e-mail, medical bill, medical report, attorney letter, state filing, etc. in their files.
The adjuster also needs to have good communication with the injured employee. When an adjuster establishes rapport with an injured employee early on in the process, the probability of future attorney involvement is decreased. The adjuster will also be better able to identify any compensability issues and to make timely payment of benefits. In a severe claim, early employee contact will help with immediate medical management.
Use a contact form designed to gather information. Initially, you should use the form for a live interview. On subsequent contacts, you might want to continue to have live conversations rather than just having the adjuster fill out the form. This allows both of you to sign off on the document.
We have a form that will help you to remember to ask all appropriate questions in every case. You will also be using the same language each time you have a workers’ compensation claim. This will remove individual personal differences from what should strictly be a professional arrangement.
Include all the basics. Even if this information is documented elsewhere, it is important to include all basic data. It is easy for a simple mistake or misread number to be repeated if just copied over and over. These typographical mistakes can lead to big hassles in getting employee medical records if not corrected. Be sure to include:
o Employee social security number
o Date of injury
o Your company name
The employee’s current condition. The adjuster should be informed about the injured employee’s current medical condition and whether the injury requires physical therapy or surgery.
The employee’s medical history. The adjuster needs to know about the injured employee’s medical history as this may affect the causality of the injury, the course of treatment and what a typical timeline for recovery may be.
The relationship with the doctor. Ask the adjuster what their relationship is with any medical providers and whether thorough communication is being provided.
Claim validity. Document if there are any questions as to the validity of the claim and about the employee’s attitude about returning to work.
Specific time deadline. Give your adjuster a deadline, no more than 24 hours in advance, for the adjuster to get back to you with specific suggestions as to how to resolve the case.
Workers’ Comp Cost Containment Program
Your adjuster can also help you implement your workers’ comp cost containment program. Once you implement your program, gain your adjusters’ cooperation and participation by telling them you appreciate them.
Author Michael Stack, CEO Amaxx LLC. He is an expert in workers’ compensation cost containment systems and helps employers reduce their workers’ comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is a co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder & lead trainer of Amaxx Workers’ Comp Training Center .
Contact: [email protected].
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