The Importance of Being….An Adjuster

7K0A0192Workers’ comp claims handling would not be possible without the care and expertise of claims adjusters. We have been highlighting workers’ comp adjusters all year long and in this series we are going to look at the different stages of the claim where the actions taken by the adjuster have the potential to greatly impact the outcome of the claim. Through their dedication and knowledge they can guide the claim towards a positive outcome. In this first post we will talk about the best practices an adjuster can take right after an injury occurs.

After an injury the initial steps taken by the adjuster are crucial. Most of the time people think it’s just writing down information and establishing facts of the claim. But the adjuster can do so much more than that.

The first thing an adjuster can do is make themselves familiar with the claimant and the employer. A friendly and familiar face can go a long way in making the injured worker feel like they are being taken care of, and if the employer knows their worker is in good hands they will feel more secure that the claim is not going to go south and they could end up in a lawsuit. If an adjuster is aloof and only has the time to administer the claim that’s not a good start. Later on down the road they should also keep in constant communication with the worker, employer, and whatever doctors are involved so they have a better idea of how the case is going.

As an adjuster is asking those basic medical questions, rather than quickly go through the list they can take the time to analyze the answers to see if they might have any impact on the case. For instance, a question about medical history might not be directly related to the work injury, but if the adjuster recognizes that they have a condition that could affect the way the injury is treated they can address that right away- rather than several weeks into the claim when something goes wrong. It can take a little bit of work but it is ultimately easier, and less costly, to control medical issues from the beginning.

While all adjusters work hard, some are more experienced in certain areas or specific cases. It is important that they are the adjusters that are assigned because their prior knowledge can guide that case much better. They will know the questions to ask and the warning signs to look for, should someone try to bill for unrelated claims or is trying to defraud the payer. An experienced adjuster can recommend certain doctors or return-to-work duties that they have experience with.

It is important to get to these things as SOON as possible, and adjusters know that. The reality is that many adjusters are busy buried under paperwork, looking up documents, entering information etc. There are systems that can automate these tasks, freeing up the adjuster to spend the time on the human elements of a claim. That humanization is often the crucial element to any case, and it is important that organizations allow their adjusters the time to do that. The more time an adjuster can spend listening to and working with their claimants, the better the outcome of the case.

What's your take? Continue the discussion with others over at the WCInsights LinkedIn Group.
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