Adjuster Selection Attributes That Will Save Workers Comp Costs

Self-insured employers with successful workers’ compensation claim management programs know one key fact – the better the adjuster, the lower the claim cost. Whether the self-insured employer has dedicated and/or designated adjusters at the third party administrator, or utilize their own in-house adjusters, the selection of the best adjusters can be tricky. 
Too often self-insured employers make the mistake of judging adjuster quality based solely on the ability of the adjuster to maintain rapport with the employer. While rapport is important, there are several other key traits the self-insured employer needs in each adjuster handling their workers’ compensation claims. Successful adjusters have many attributes. Four primary attributes the self-insured employer should look for in the adjuster selection process are:
  • Communication
  • Documentation
  • Proactive
  • Courteous
 
Communication:
Few things are more dangerous to the self-insured employer than the workers’ compensation adjuster who does not communicate openly and often. Major claim developments that are unknown to the self-insured employer can wreak havoc. With open communications between the adjuster and the employer, the employer is kept informed of each claim’s progress. Open communications allows for the exchange of information about the claim and ideas on how to assist the injured employee while moving the claim forward. Open communications with the adjuster is not for the employer to micro manage the claims, but to facilitate collaboration and claim progress.
 
Documentation:
The best workers’ compensation adjusters thoroughly document their files. Each phone call, e-mail, medical bill, medical report, attorney letter, state filing, etc., should be documented either in the file notes, the documents section of the file, or both. If the adjuster accepts employment elsewhere, takes ill, or for some other reason is unable to continue the handling of the claim, the next workers’ compensation adjuster who picks up the handling of the claim should be able to review the file and know immediately both the former course of the claim and the current status of the claim. 
 
Proactive:
The adjuster who allows the workers’ compensation claims to take their own course, rather than directing and influencing the claims, provides little benefit to the self-insured employer. The adjuster who takes charge and actively manages each aspect of each claim keeps the number of unpleasant surprises to the minimum. Ordinary claims that are not actively managed by the adjuster frequently take a wrong turn and become more complex (and more costly). The proactive adjuster will coordinate and manage the medical care either directly or through a nurse case manager. The proactive adjuster will arrange for the employee to return to work light duty. And, the proactive adjuster will coordinate all other aspects of the claim before there is a need for action.
 
Courteous:
When a workers’ compensation adjuster is not courteous to everyone in every facet of their claim handling, the resolution of the claim becomes more difficult to achieve. Courtesy is much more than the adjuster being polite on the telephone. Each missed telephone call should be returned as soon as possible, preferably the same day. Each email that needs a response should be promptly replied to.   Each paper correspondence that requires an answer should be addressed right away. 
Courtesy is especially important with injured employees. While a non-injured employee would over-look any unintentional slight, an injured employee who is already anxious about his/her future health and employment, will often take any bluntness or perceived lack of courtesy as the employer and the work comp adjuster not caring about their well-being. A lack of courtesy by the adjuster frequently results in the injured employee obtaining an attorney, which delays the claim resolution while increasing the claim cost.
 
Other Attributes of an Excellent Adjuster:
While the four attributes listed above are key to the successfulness of an adjuster, there are several other traits the self-insured employer should look for in the selection of an adjuster. The following attributes are also important, and should be evaluated in the adjuster selection (and retention) process. 
  • Negotiation skills
  • Organizational skills
  • Time management skills
  • Customer service skills (customer being both the self-insured employer and the injured employee)
  • Work ethic
  • Ability to prioritize competing demands
  • Compliance with Best Practices
  • Technical expertise
 
If you find all of these attributes in one adjuster, it is definitely an adjuster you want to handle your workers’ compensation claims. While few adjusters will be strong in all of these areas, the greater the number of positive attributes the adjuster candidate has, the better his/her selection will be for your company.
  
 

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 author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com
 
 
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com
 
©2013 Amaxx Risk Solutions, Inc. 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 about workers comp issues.

8 Ways to Grade Your Workers Compensation Claim Adjuster

Often it is assumed the designated adjuster(s) working on your workers compensation files is a good adjuster. But, you know what “they” say about “assuming.” Use these eight tips to judge your adjuster(s) overall ability and effectiveness.
 
 
1. Timely Contact with All Parties
Track how often the adjuster makes timely contacts. If your Best Practices say claimants, medical providers, and the employee's supervisor must be contacted within 24 hours of the first report of an accident, expect your adjuster to be making timely contacts with all parties at least 90% of the time. The higher the percentage, the better. Timely initial contacts go a long ways toward establishing the future tone of your claims and establish the adjuster as the person in charge. (WCxKit)
 
 
2. The Accuracy of Reserves
When you look at your loss run and compare what the claim settled for against the claim reserves you gain insight into the ability of the adjuster to evaluate the claim. If you see a lot of reserve changes right before the claim settles, then the adjuster is either inexperienced at evaluating the claim or is indifferent to the impact reserves have on your company. If you see the reserves on the claim were established since the adjuster obtained key medical information on the injured employee, you know the adjuster is looking out for your financial interests.
 
 
3. Responsiveness
Does the adjuster always answer the phone when you call, or do you often have to leave messages and wait a few days to hear back? When you send e-mails, do you get a prompt response, or do you forget what the subject of the e-mail was by the time the adjuster responds? A good adjuster tries to keep you informed about your claims and takes the time to respond to your questions and needs. The quicker the response from the adjuster, the better the adjuster.
 
 
4. Payments Timely
If your employee complains the TTD or TPD check did not arrive on time, then the adjuster is not organized (or may have too many claims to handle properly). You should expect never to hear from an employee about the indemnity check not arriving. If your employees are receiving dunning notices from their doctors on medical bills, then the adjuster is not processing the bills timely. While any adjuster may occasionally have a medical bill or other missed expense, you or your employees should not be constantly getting reminders on medical bills.
 
 
5. The Number of Employees Lost to Attorneys
The good adjuster stays in contact with employees out on workers comp. The great adjuster builds rapport with the employees and the employees make an effort to keep their adjuster informed as to their medical progress and their ability to return to work. The poor adjuster has a higher percentage of employees represented by an attorney then the good adjuster. As the percentage of employees represented by attorneys is impacted by the legal climate in your locale, you must consider the results of your adjuster compared to other adjusters in the same locale.
 
 
6. Knowledge of Workers Compensation
When you have a question about workers comp in general, the good adjuster can answer it for you, (or at least get you the answer). If the adjuster does not know the answer, or tells you it would be better for you to talk to a workers comp attorney or the adjuster's supervisor, the adjuster's workers comp knowledge is weaker than it should be. The good adjuster knows all the ins and outs of state statutes and is willing to share that information with the employer.
 
 
7. Claim Quality Audit Scores
Often claim offices do not want to talk about their claim quality audit scores. This often arises out of a concern that the employer may not understand that the 100% perfect claim file seldom happens. However, the good workers comp adjuster scores in the 90+ percentile. Ask the adjuster for a copy of the most recent audit score. The good adjuster is glad to share it with you. The weak adjuster probably has reasons why it cannot be shared.
 
 
8. Closed Files Reopened
Every adjuster knows the best file is the closed file. However, it is seldom a good idea to close a file prematurely. The good adjuster makes sure all aspects of the claim are resolved, all medical bill paid, all indemnity checks issued, and all expenses paid before closing the file. If you see more than a few reopened files on the loss run report, than the adjuster is closing claims prematurely. (WCxKit)
 
 
None of these 8 criteria alone indicate a good or poor adjuster. When the adjuster is strong in all 8 areas, you have a great adjuster working your claims. If the adjuster is weak in most of these areas, it is time to consider requesting another adjuster to handle your workers comp claims. Having a strong adjuster on your claim files makes your life easier and saves money. A few select TPA's DO actually "grade" their adjusters, giving monthly bonuses to those that excel, and get high grades – nearing 100.
 

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website 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. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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