Workers Compensation Claims Adjuster Has 13+ Job Duties
The Workers Compensation Claims Adjuster – this is an excerpt from a manual I wrote 10 years ago. The only area I would add is the MSA component.
One of the most thankless jobs in insurance is the claims adjuster position. This manual may point out how file reserves and closings are handled by an adjuster.
It is not the adjuster, but the WC 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. 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.
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 WC $ on page 19 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.
There are numerous tasks in a Workers’ Compensation claims adjuster’s job:
1. Investigate claims within 24 – 48 hours after receipt of the First Report of Injury.
2. Provide benefits to injured employees.
3. File proper forms with State WC Board.
4. Set initial reserves on new claims and review reserves on established claims (usually for increases).
5. Pay bills on claims (medical, rehabilitation, defense attorney).
6. Settling claims.
7. General clerical functions.
8. Completion of periodic claims status reporting to insureds, carriers, and/or reinsurers
9. Maintaining up-to-date file documentation of any development on the claim including phone calls, correspondence received and sent, review of medical notes, etc.
10. Minimum of monthly reviews of the claims (via diaries) to assure the claim is proceeding accordingly toward closure. Maintain and update periodic action plans to move the claims toward closure.
11. Authorize and schedule medical appointments for the injured employees and follow up for receipt of medical documentation including work status reports.
12. Follow up with employers to determine if work is available for the injured employee (limited duty or full duty) and/or assign vocational rehabilitation to assist the claimant in finding alternative work to lessen exposure.
13. Review files for reserve reductions or closings.
Please note that reviewing reserves for reductions and file closings is the lowest-rated priority on the task list for claims adjusters. Why are they the lowest priority in the adjuster’s daily tasks? It is the nature of the insurance system.
Your efforts should be focused on the parts of your WC claims that will reduce the amount of time the adjuster spends on tasks #1 – #12 and increase the amount of time the adjuster spends on #13.
That is why it is so important that you review your monthly or quarterly loss runs upon receipt. If you see files that should be closed or reserves that are too excessive, email your workers compensation claims adjuster.
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