Work Comp Roundup

Depending on past experience with workers’ comp adjusters, you may or may not have an accurate picture of their daily work life. Every adjuster has a unique style. Sometimes that style meshes well with the way with an employer’s way of doing business and sometimes it may not. Whatever the personality may be, the adjuster has the same goal the employer does. And that is to move the claim to resolution by return to work, release from medical care, or to redeem the claim through litigation if needed.

A good percentage of workers’ comp adjusters have multiple insureds (employers) they work with, in multiple states. Some of these insureds are very demanding, and some are not.   Some are very open to new ideas to get injured workers back to work, and some are not. The adjuster is always a chameleon, blending the personality and way of working to match what the insured wants while at the same time trying to read and gauge the claimant to judge for any indication that there may be more to the injury than what appears on the surface.

Whatever the personality or work ethic of the adjuster that handles the account, below are 5 ways to get them to work harder. Working as an adjuster handling work comp claims is a very stressful, demanding, high exposure, and thankless job. In any scenario, the adjuster will do what it takes to get the job done on the files, but these 5 little tidbits of info we discuss below may be able to maximize the adjuster’s role.

• Complete all fields of First Report of Injury

The First Report of Injury is the first info the workers’ comp adjuster reviews when assigned to a new claim. Nothing irritates them more than having a lot of missing information. It almost can reflect the way the claim is going to unfold during the investigation. If an adjuster sees a half-completed injury report when they call and ask you about the details of the injury they are expecting the employer not to know anything about it. Completing the injury report will reflect the employer’s professionalism to the adjuster. Another insured may complete every line, and the adjuster will view that as “This insured is very detailed and involved and will be watching every move I make, so I better make the right moves to impress them right off the bat.”

Plus the adjuster has to obtain a lot of that information anyway. So it will save some time on the phone call if as an employer, you obtain the information before submitting the claim into the adjuster. State reporting requirements will demand the date of birth, social security number, complete address, and other additional info. So take the extra 10 minutes and complete the State injury form. This way the adjuster can get a good idea about what happened and can hit the ground running for the start of an investigation.

• Stay involved and open to ideas

Not every employer is the same. They are different sizes, different types of people, different demands, and different cities. Everything is different, and this makes being an adjuster that much more difficult. The adjuster may not know that the employer does not have any light duty work at  the shop, but how deep have you as the employer looked? The adjuster may have ways to sneak a few of these guys back to work, and that will save the employer money. The adjuster’s job is to get injured workers back to work. Most of the time the roadblock to obtaining this is the employer, not the injured worker.

Let the adjuster come out to the shop (if they are local) and let them walk around and evaluate things. Talk a little bit about the other types of jobs you do that your injured worker may be able to do. Discuss not only full-time jobs but part-time as well. Part-time work is overlooked a lot, but any sort of savings is worth it. 10-15 hours of work a week is better than the injured worker sitting at home doing nothing but collecting a paycheck. Plus remember the old adage: The longer a claimant is out of work, the more difficult it is to get them back. Collecting 70% of pay in addition to saving on daycare costs or gas costs to name a few. Better to keep an open mind about getting the injured party back to work.

• Return calls/emails to the adjuster

The workers’ comp adjuster has a lot to do every day. Claims are in various stages of a lifespan, and the job of an adjuster involves being on the phone a great deal. The new trend is to try and email as much as possible. It is a lot faster than a phone call, and it allows the other party receiving the email to get to it when convenient. Answer or return that email.  It does not have to be within the same hour, but it should be at least the by the end of the business day. The adjuster wants something or has a question they need to be answered.   Usually, the adjuster cannot move forward on the claim until the info is obtained. Do not be known as a slowpoke in getting the adjuster this information. They will respond in kind when the employer needs something.

• Be polite

The workers’ comp adjuster usually deals with conflict. Conflict with different physicians and their opinions. Conflict with claimants over what is a work-related injury and what is not. Conflict with their managers on what to do on a file to get it to resolve. Conflict with plaintiff counsel over the facts of a case. Conflict with a claimant over a check not being issued or why the claim is still under investigation.   The list could go on and on.

So it is nice to give the adjuster some polite words now and then. A “please” and “thank you” can go a long way. Maybe take some time after a difficult claim is resolved and thank your adjuster for hours and hours of time put in to resolve the claim. Everyone appreciates the positive feedback and a good “thank you.”

• Meet the adjusters face to face and show them around

Most adjusters work from home or in an office. They do not see their claimants. They do not meet the insureds. They are not at the doctor appointments. They are not on-site in the workspace. One thing to do is to meet with them first. Talk with your carrier/TPA about getting 1-2 adjusters to work the account.   Then invite those adjusters and the claims manager over to meet face to face at the workplace. Take them on a tour of the facility. Let them meet the safety team. By putting a face to a name, you have personalized the experience. And the more contact, the better the resolution on claims. The same employer/client relationship applies to the carrier/agent/adjuster relationship.

Summary

The workers’ comp adjuster has to handle many claims from many different employers. So make yours stand out from the rest. Take that extra time to build a relationship with the carrier/adjuster/TPA.  Claim results will likely be better.

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: mstack@reduceyourworkerscomp.com.

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

©2018 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.

THE MOST IMPORTANT PART of and adjusters initial handling of a workers’ compensation claim is the contacts with the parties involved in the claim. The contacts are often referred to as “three-point contacts” which refers to the three principal players the adjuster is involved within every workers’ comp claim. The three principals are the employee, the employer, and the medical provider.

To successfully handle a workers’ comp claim, it needs to be investigated both timely and thoroughly. The contact with the injured employee, the employee’s supervisor and the employer’s claims coordinator, and the medical provider all provide valuable information to the adjuster in the handling of the workers’ comp claim.   Each of the contacts, if properly managed, allows the adjuster to maintain control of the developing claim.

Definition of Contact

A recent audit of a claims office found the definition of “contact” was not spelled out in the claims handling requirements or the company’s Best Practices. The workers’ comp adjusters were sending form letters to the employer and the employee saying “call me” on the day they received the assignment. Their supervisor was accepting the form letters as contact with the employer and employee. The adjusters and supervisor were bending the meaning of contact to their own purposes and not making proper three-point contact.

Three-point contacts are almost always be handled by telephone, except in severe cases where an in-person contact would be justified. With most adults having cell phones, there is no reason for not making voice contact. If the principals cannot be reached by telephone, a contact letter should be sent while continuing the effort to reach the principals by telephone.

The insurers who have quality Best Practices consider voice contact as “the exchange of information between the principals and the adjusters.”  Leaving a message on the employer’s or employee’s voice mail is not considered contact in the true meaning of three-point contact.

Timeliness of Three-Point Contact

Each workers’ compensation insurer and each third party administrator (TPA) has set their own time frames as to when three-point contact should be completed. Some insurers are requiring their adjusters or TPA to make three-point contact within 2 hours or 4 hours of the time of the accident. Other insurers and TPAs are being less stringent and requiring the three-point contacts to be completed within 24 hours or 48 hours of the time of the assignment.

Workers’ comp adjusters prefer the 48-hour goal of making three-point contacts as that is a relatively easy goal to make. Various studies, however, have shown that immediate (same day) contact has the most positive influence on the outcome of a case.

While the goal of the adjuster should be to make the three-point contacts the same day as the assignment is received, in reality, the other parties to the claim may not be available. Persistence is an absolute must for the adjuster. If the adjuster has left a voicemail for the employer, employee or medical provider’s office, the adjuster should call again if the other party has not responded by the end of the workday. The persistent adjuster will leave at least two voice mails the day the assignment is received and will follow up with a contact letter if a response is not received. The adjuster should continue to try daily to reach each of the principals of the claim until voice contact is made with them.

Employer Contact

Upon receipt of the new assignment, the workers’ comp adjuster immediately verifies coverage for the insured/employer. If there are no coverage issues or questions, the adjuster’s next step is to make contact with the employer.

The purpose of the employer contact is several fold. The Employer’s First Report of Injury has essential information the adjuster needs but normally does not contain all the information that would be of value to the adjuster in accessing the claim. By discussing the accident with the employer’s claim coordinator, the adjuster can learn additional information that may be helpful in the development and handling of the claim. Some of the information the workers’ comp adjuster can obtain from the claims coordinator includes

1. Prior claim history of the employee
2. Verification of the facts on the Employer’s First Report of Injury
3. The return to work status or the disability status of the employee
4. Description of job duties
5. Availability of modified duty or light duty work
6. Length of employment
7. Identification of employee’s supervisor and witnesses to the accident
8. Subrogation potential

If there are any questions about the circumstances of how the claim happened or any issue of any kind, the adjuster will need to also interview the employee’s supervisor about the workers’ comp claim. A recorded statement from the supervisor may be necessary if the facts of the claims are questionable, if the claim appears to be severe, or if there is the potential for subrogation.

If there are still questions about the claim after the adjuster has spoken to the employer’s claims coordinator and the employee’s supervisor, the adjuster should also interview any witnesses to the accident.

Employee Contact

The adjuster’s prompt contact with the employee will build rapport and assist in establishing a non-adversarial working relationship with the employee. When the adjuster establishes early contact with the injured employee, the probability of future attorney involvement is decreased. The adjuster is also in a better position to identify any compensability issues and to make timely payment of benefits, both medical and indemnity. If the claim is severe, the early contact with the employee will allow for immediate medical management.

When the adjuster makes the initial contact with the employee, the adjuster should consider a recorded statement if the accident is severe or there is potential for subrogation. Also, the adjuster should consider a recorded statement if there has already been inappropriate or excessive medical treatment, if there is a pre-existing condition, if the claim is for a serious occupational disease, if there were other employees injured in the same accident or if there any question of compensability. Whether the interview is recorded or not, the initial conversation with the employee should cover:

1. The facts of the accident
2. The identity of any witnesses
3. A description of the employee’s job, including job title, job requirements, equipment utilized, etc.–  (this will assist the adjuster in arranging for an early return to work on modified duty or light duty)
4. The details of the injury and the medical provider’s proposed treatment plan. This should include the medical provider’s diagnosis and prognosis, the employee’s comments about pain, medications, prior injuries, treatment issues, etc.
5. The employee’s attitude about the employer, the accident, the medical treatment, the willingness to return to work, etc.

The adjuster, during the initial contact with the employee, should advise the employee of all state required forms that will be sent to the employee and in those states that require a medical authorization, advise the employee of the importance of signing and returning the medical authorization immediately. The adjuster should request a copy of any off-work notes from the medical provider. The adjuster should also advise the employee of the actions the adjuster will be taking and encourage the employee to contact the adjuster with any questions, issues or problems.

Medical Provider Contact

The medical provider whether an occupational injury doctor, a hospital emergency room or a walk-in clinic, should be contacted by the adjuster as part of the three-point contact. The adjuster purpose in contacting the medical provider’s office is to obtain the necessary information to determine the process the claim. They would include:

1. The diagnosis
2. The prognosis
3. The estimated length of time before the employee can return to either light duty or full duty work
4. The date(s) of the next medical appointment(s)
5. Information on any referral to another medical specialist

The adjuster should advise the medical provider to send to the adjuster the complete medical records including the medical history provided by the employee, the doctor’s notes, the results of any testing and a copy of any off work slips provided to the employee.

Summary

The importance of three-point contact cannot be overstated. Getting the claim file off to a proper start has a major impact on the course of the claim and the adjuster’s ability to handle the claim fully and properly. By completing a timely and a thorough three-point contact, the adjuster sets the tone for the outcome of the claim.

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:.

Contact: RShafer@ReduceYourWorkersComp.com.

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

©2018 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.