We always love hearing from our readers and this week they nominated a truly dedicated adjuster. Josie M Sanchez is a Claims Adjuster/Analyst from Wyoming Workers’ Compensation. Her nominator was impressed that she seemed to be in constant contact with her workers, employers, and doctors. She uses her employer contacts to successfully help her injured workers get back to work. She’s really got a great return to work story and it is because of adjusters like her that injured workers can find hope and get their lives back on track after a devastating injury.
Do you have a start adjuster in mind that you’d like to nominate? Let us know here.
WCInsights: How long have you been at your position?
I’ve been with Workers’ Compensation for 18 years, two as an administrative assistant (learning how to be an analyst) and 16 as an analyst.
WCInsights: Your nominator commented on your excellent case management skills and your first steps when you contact a worker. Could you expand on that?
Our Agency requires a three point contact when we first get a claim; the employer, the employee, and the health care provider. This ensures that everyone knows the status of the claim, the claim number, and what is needed to continue the opening process. On the first contact, the claimant is given all the information up front on what I expect from them, to keep me notified of any changes to his/her claim, any upcoming surgery, order for PT, new Rx’s. etc., as the Division sometimes does not get medical records to update us in a timely fashion. If a new order comes in for any treatment, I’ve already had a call from the claimant and there is no delay in approving treatment for them. This continues throughout the claim.
We also are required to speak with anyone on temporary total disability at least once per month but again, I have my claimants calling me to update me after appointments and even surgery just to keep me up to date. This keeps any prescriptions they have from being held up for approval or any other appointments being scheduled, as I’ve already heard from them. I also give them options to email or call and just briefly tell me what’s going on. This takes less time than me trying to figure out why they are getting something new. Some require less management some more depending on the injury. I have a great re pore with my employers and the health care providers. They know my management of the claims is important to get them back to work and/or rehabilitation.
WCInsights: What is the most rewarding part of being an adjuster?
The thanks I receive from someone who had a positive experience working with me. Someone who says they just knew it would be the worst experience because people had told them to be prepared to be treated horribly and they get me and say that I proved them all wrong because I helped them work through the process so easily. It’s so rewarding to hear that someone felt I did a good job for them. It’s always because I care for each and every one of them. We want them to return to the jobs they were dong prior to the injury and for the most part this is the job they love. But when I need to send someone for retraining who is any age, the greatest experience is getting through the claim and seeing that they got an education and are able to make a rewarding life with a new career.
WCInsights: What is something that does or would make your job easier?
Because we are so fast paced, we are so busy all the time, having a good working system that actually works for you and is quick and easy to use. I am currently on a committee, which is in the process of creating a “claims management system” on our current system which will help everyone be consistent with case management and easy to access. This will be utilized by all the analyst/adjusters to keep good records on managing the claims.
WCInsights: What is something you personally do that you think makes the job better for you?
Smile! I try to have a good attitude about my job. I tell everyone that I love what I do. So the attitude I have makes my job easier to do. There are always frustrations because there are always things that don’t go like I’d like them to go but, it’s the joy in helping people and making sure that I’m a good advocate in helping them get through a difficult time in their life.
WCInsights: How do you stay on top of claims?
It’s difficult to stay on top of all the claims we get daily. I need to prioritize and those priorities change sometimes every minute, so an analyst needs to be versatile. I change what I have to do every day. As long as I know that my claimants are paid for their lost time and I return calls as soon as I get the messages. This can save you time as you start doing your work.
WCInsights: If you had more time in your workday, what things would you do?
More case management. It’s important to manage all your claims. We don’t have the luxury of being able to manage every claim but ideally it could save so much time and things could run so much smoother. I’m hoping that with the new case manager system we are currently working on will help all the analysts manage their claims. Being a senior analyst we know the importance of the management part, the younger analysts are still learning and some still are not even sure how to manage a claim. Just being able to enter information on each claim as the claim ages can help everyone be on the same page.
WCInsights: Could you share a story of getting an injured worker back to work that had an impact on you?
Just recently I had a gentleman who had a back injury and he was not going to be returning to that occupation. This man had worked that occupation for 30+ years. When he was released to work I gave him the option of taking the permanent partial disability award which is a monetary amount based on his education, age, job experience, etc. This is a one-time award and the money end looks so appealing. This award vs. the vocational side of it. The purpose of this is to get them retrained into a new career; however, he was already 59…. at this point he felt so defeated because when he was working he just knew he was going to be in that one career until he retired someday but after an injury that dream is gone. So, I talked him into going to school. He didn’t want to, feeling that he would fail. He hadn’t been in school since he was 18. But once he got going he was so encouraged that he went back into the same career only doing the business aspect of it. He graduated this last spring and has started his own business giving estimates. He came in three weeks ago to just say “THANK YOU JOSIE, I never dreamed I could do what I’m doing now without your pushing me to extend myself.” That’s the greatest gift of all that I helped him see he could do it…never give up!
WCInsights: What’s one tip that you could offer to other adjusters?
Try to always keep that smile and keep yourself level to them. Put yourself in their shoes to understand what they are going through. It may be difficult to see yourself being a laborer but realize that this is all they know. Just like what we do, is about all we know; and when a life changing situation occurs it affects everyone. Have some compassion and empathy for the changes an injured worker has to live through. I always say, it’s like experiencing death. They mourn their life as it was and we are the only link to a better life beyond.