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Workers Compensation Claims Adjuster – Friend or Foe?

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The Job Of  A Workers Compensation Claims Adjuster

A Workers Compensation claims adjuster – are they friend or foe?  Many years ago, I started out my career as an insurance adjuster trainee.

Vector Graphic Of Mens Workers Compensation Claims Adjuster On Job
StockUnlimited

The adjuster has more to do with your Workers Comp premiums than any underwriter, agent, or premium auditor. I thought I would go over a few interesting and probably unknown aspects of a very tough job in the insurance industry.

One of the most thankless jobs in Workers Compensation or any other type of insurance is the claims adjuster position. In this blog, I may point out flaws in how file reserves and closings are handled by an adjuster. It is not the adjuster, but the Workers Comp insurance system as a whole that causes overcharges in employers’ premiums. The claims adjuster is the “mediator” between the claimants and the respective insurance companies. The claimants want to be reimbursed or provided with whatever they ask, and the insurance company wants the claim to be settled for the least amount of funds possible, without the costs of litigation.

Picture Man Using Laptop Workers Compensation Claims Adjuster Job
123RF

Most claims adjusters are overloaded with claims. A claims adjuster must be the master of time management or they will quickly drown in their claims load. A usual claims load is from 125 – 300 files. If the claims adjuster has over 200 files, you as the customer, are not having your files handled properly. There are a very few adjusters who can handle more than 200 files. If your files are split amongst numerous adjusters, each of them still needs to be handling 200 files maximum.

Anything that will help a claims adjuster do their job can only help keep your reserves as low as possible. The Four Secrets of Saving Workers Compensation premium that I posted previously will help reduce the amount of time spent by the adjuster on your WC files. An adjuster only has so much time to devote to each file, so any extra time that you can give the claims adjuster will enable the adjuster to spend time on your files trying to reduce your costs, not just working on the files.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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