Some objectives of every workers’ compensation claim adjuster should be to:
- Promptly investigate.
- Monitor medical care.
- Process the workers’ compensation claim to a timely full disposition.
- Maintain a constant dialogue with the employee, employer, and all other entities directly connected to the loss.
- Secure any potential recoveries.
- Develop the loss for the best outcome possible.
- Be adequately educated, trained, and continually self-educated for continued professional growth.
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- Clearly, compensable claims should be paid promptly at the proper benefit rate, medical care should be the best available, and prompt return to work should be a priority.
- The adjuster should be available to assist the injured employee as needed.
- Good claim work results in minimal disability, good employee relations, and lower claim cost.
- Conversely, claims that are questionable, malingered, fraudulent, or suspect for any reason, require the claim adjuster to be extra determined so that a good investigation and claim preparation can sustain declination and litigation.
- Workers’ Compensation Claims are always under time guidelines and handling pressure. Decisions and actions must be made or done quickly.
Employer Injury Coordinator & Assisting The Adjuster
The adjuster has primary responsibility for successful claim disposition. However, the adjuster can only be as effective as the information gathered during investigation. Therefore, every employer should strive to get the full facts, and supporting documentation to the adjuster as soon as possible after the loss occurs.
Every employer should have at least one person assigned to establish policy and procedures to implement when an injury occurs. The person should know and understand all requirements of the workers compensation management program, including the employer and employee responsibilities.
One of the biggest responsibilities of the employer injury coordinator is communication with the claim adjuster. This should be done as necessary, and during acute stages of a claim it may be daily. As time passes on this claim this should continue on a regular weekly schedule.
Conclusion:
Worker’s Compensation Adjusters need to have good education, training, and the highest objective standards in order to reach proper handling and resolution of claims. However, they cannot achieve this without proper employer support and interface.
Employers who designate an employee to be the workers’ comp injury coordinator to assist the claim adjuster will reap the benefits of better claim handling and cost.
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 the founder & lead trainer of Amaxx Workers’ Comp Training Center, which offers the Certified Master of Workers’ Compensation national designation.
Contact: [email protected].
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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.
