Your Adjuster May Be Carrying 200 Claims. What You Can Take Control Of

There is no single number every carrier and TPA works to. Each one sets its own caseloads, and they shift with the type of claim and how complex the files are. What the data does show is how heavy those caseloads have become. In a national survey of 1,388 frontline claims professionals, about one in four who handle lost time claims reported carrying more than 150 claims, and 8 percent more than 200 (Rising, 2023 Workers’ Compensation Benchmarking Study, published 2024).

Medical only adjusters carry more. In the same study, 29 percent of them reported caseloads above 200. For contrast, the study cites a two year case study that set a maximum caseload of 111 lost time claims per adjuster (Kern, 2019, as cited in the Rising study). And in the programs we work with, we regularly see adjusters carrying 200 or more claims.

So the honest answer to “how many claims should an adjuster handle” is fewer than many of them do. The more useful question for an employer is what happens to your claims inside that caseload.

Your claim gets about 12 minutes a week

Say your adjuster carries 200 open claims for 18 different employers. Give every hour of a 40 hour week to the files and each claim gets about 12 minutes a week. That 12 minutes has to cover every call and every payment on the file.

Now say 30 of those claims are yours. Your whole program gets about six hours of the adjuster’s week. In those six hours the adjuster also has to remember how your company wants things done, out of 18 sets of account instructions that all say something a little different.

Nobody would design it that way on purpose. It is still how a lot of claims get handled.

An overloaded adjuster fills the gaps with defaults

Most account instructions state a philosophy. “We support return to work.” “We prefer aggressive claims management.” Those lines sound like direction, but they leave the adjuster to work out what they mean on a Tuesday afternoon with a full inbox. Who do they call about modified duty? Is there a job available? Can they authorize an investigation, or do they need to ask first?

With minutes per file, the adjuster does what their own office’s process says, or waits for someone at your company to call. That is not a failing of the adjuster. It is what happens when the decisions that belong to the employer were never made, and nobody wrote them down.

What you can take control of

None of this needs your adjuster to have more time. It needs your company to make the decisions once, so the adjuster never has to guess.

• Report every injury fast and complete. The Amaxx standard is within 24 hours, with the job, the supervisor and a contact name on the first report. The first hour after an injury decides how much the adjuster has to chase.
• Give the adjuster one named contact at each location for wage information and modified duty, and a backup for when that person is out.
• Write instructions as decisions, not beliefs. Each one says what triggers it, who does it, how fast, and who must be told. Here is how to test every line of your account handling instructions against those four questions.
• Decide in advance what the adjuster can approve without calling you, such as an investigation on certain triggers or settlement up to a set amount. The difference between “may” and “must” in that language decides who is really in control.

Each of these is simple to define. The hard part is getting every location and every supervisor to run them the same way, every time, so the adjuster sees one company instead of five.

What the answer says about your program

If your claims only move when your adjuster has a spare minute, or when someone at your company remembers to call, the program is running on the adjuster’s caseload and not on anything you control.

Here is a check you can run this week. Pull three open lost time claims from different locations. For each one, ask what the adjuster was told to do that they did not have to work out for themselves. If the answer changes depending on which location the claim came from, you have preferences, not a system.

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