Your Medical Only Claim Adjuster Important Team Member
The Medical Only claim adjuster is the person that are usually handling the more serious medical only claims.A large number of our clients have received our heavy recommendation to get to know their lost time claim adjuster(s). The adjuster(s) have a huge effect on your company’s Workers Compensation premium. We are often brought in as consultants to discuss files with the claims adjusters.
One group of personnel that almost no employer or risk manager establishes a working relationship with is the Medical Only adjuster. Why is this so important? I have coined the term – festering claims. The Medical Only adjuster is the person that are usually handling the more serious medical only claims. The Medical Only adjuster also handles the claims by paying the medical bills on a very large group of claims. I have rarely seen a carrier where the lost time adjuster handles medical only claims.
I have seen so many serious claims not being handled properly as there seems to be a communication breakdown when the lost time adjuster is not handling the file. The employer will inform the lost time adjuster of a development on a medical only file. The lost time adjuster then has to hand off the info to the medical only adjuster. Often the necessary attention for a “festering file” is not given.
The file will then not have the proper investigation initiated until the loss control on the file is beyond repair. This type of file is much worse than a file that has had the attention of the lost time adjuster since day one.
I am not blaming anyone. This is just the nature of the beast in the Workers Comp claims industry. The claims industry is a sink or swim business.
Who is your medical only claims adjuster?The largest concern that we have with Medical Only files is not the normal files. In our reviews, we almost always see a few or many festering medical only claims. The file has made a turn for the worse and the proper investigation is delayed as the medical only adjuster’s job is to facilitate the timely payment of medical bills, not adjust the file. They are usually overloaded with hundreds upon hundreds of files.
The other situation we see with festering medical only claims is when the employer has not informed the medical only adjuster that the file is now becoming a more serious matter.
The backstop for both of these situations is when the file reaches a large amount of medical payments and the file pops up on the carrier’s or TPA’s radar. These can turn out to be very expensive files in the long run.
As I have posted very often, an employer that has online access to their Workers Comp claims will usually have a great advantage. While it is the job of the adjusting staff to watch over claims that are becoming more serious, the employer can call attention to the claims that are reaching large $ amounts but are not classified as lost time files. One of the huge red flags is a very large medical bill or bills with numerous dates of treatment.
As the title indicates, knowing your medical only adjuster or adjusters makes the process of alerting the carrier of to a more serious medical only. An email to the medical only adjuster with a cc: to the lost time adjuster works very well. It is not a good idea to assume the claims adjusting process will take care of itself.
All of our clients do know who their Workers Comp lost time adjusters and medical only adjusters are on their company’s files and have realized premium savings on this simple tip.
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