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Liability Adjusting Is Part of Workers Compensation Claims

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Liability Adjusting Enables Great Workers Comp Adjusting

One of the more complex liability adjusting components of  Workers Comp claims is subrogation.

Picture Of Hand Illustrating Liability Adjusting With Line Graph
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Subrogation rears its ugly head (or the lack thereof) on a large percentage of Workers Compensation files.  The percentage referred to is the lack of knowledge by WC adjusters on identifying and pursuing subrogation.  Subrogation is basically placing the liability of the risk on a third party.

There are many subrogation articles in this blog.  The reason is that many carriers and TPA’s just do not fully train their adjusters on the nuances of liability adjusting other than WC.  Carriers and especially TPA’s can become very single-minded in the handling of WC claims.   This is not an indictment of any single carrier of TPA.  The problem is more systemic in nature.

A very good subrogation attorney published an article recently in the Insurance Journal.  One of the internal links provided a great summary of subrogation laws.  When one steps outside the comfort of WC liability, the process can become much more complicated.

One of the better subrogation websites included a  national map of the various subrogation laws in every state dealing with whether the state is a:

Law graphics Liability Adjusting With Gavel
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  • Contributory negligence state (bars recovery with only 1% of fault by the plaintiff) or
  • Comparative negligence state (recovery by plaintiff is reduced or prohibited based on the percentage of fault attributed to the plaintiff), and
  • Pure comparative or modified comparative state.

Kudos to the author Attorney Gary Wickert as it is one of those articles you should keep handy.  An accident may occur in other states than just the one where the WC file will be handled.   The list is not exhaustive, but well worth the read.

The reason for this article is sometimes the WC adjuster can write one letter and receive a subrogation recovery.  The key is to make sure the adjuster handling the liability file (auto, premises, general liability, etc.) is put on timely notice.  A letter by certified return receipt mail has been used as legal proof of a timely subrogation notice.  It is the best $5 an adjuster can spend to preserve the right to recover.

Liability adjusting on WC files is a training issue that needs to be addressed to recover funds that carriers and TPAs sometimes leave on the table.

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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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