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Ethics in Workers Compensation – Blogging Live – NWCDC


Blogging live – Ethics in Workers Compensation

Ethics in Workers Compensation is still very important.   This presentation covered ethics in claims handling very thoroughly.   Many states now require adjusters to have three hours of ethics at time of license renewal.  I think  the ethics component should be even larger with some of the events I have seen in my WC career.

Cloud Ethics in Workers Compensation concept
Wikimedia Commons – Teodoraturovic

Ethics for HR Specialists,  Risk Managers & Claims Adjusters

Presenter -Eugene F. Keefe, Esquire

From Merriam‐Webster, Ethics is defined as:

• A discipline dealing with what is good and bad along with moral duty and obligation
• A set of moral principles; a theory or system of moral values
• The principles of conduct governing an individual or a group
• A guiding philosophy
• A consciousness of moral importance

No Side Deals or Dealings
• Managers and Claims Adjusters must not pay, offer to pay or agree to pay any remuneration, compensation or benefit to a person who is not a valid and legitimate representative of any party in your claim, except where permitted by law
• Always seek initial proof of standing to represent – until you have it, no dealings other than to seek needed  documentation
• You may have to report someone who is not being forthcoming about their status

Takeaways Discussions Today

Two Businessman Ethics in Workers Compensation Meeting At Cafe

• When Do You Start or Stop the Money Pump in Claims?
• Handling Claims Ethically is Good for You, Your Employer, Your Vendors
and Your Accounts
• No Side Deals or Dealings
• Your Files are Being Constantly Monitored—Be the First to Report any Anomaly
• Concerns in Dealing with Family and Friends of Claimant in Non‐Litigated Claims
• How Do You Insure Someone Contacting You is An Attorney?
• What If a Lawyer Starts to Act Unlike a Lawyer to You?
• What if a Plaintiff Lawyer suggests an Expert to handle a claim issue?
• Avoid Conflicts of Interest
• Always Tell the Truth‐‐Never, Ever Lie
• Keep Your Claims to Yourself, Client and Company
• Avoid Bad Faith

Also Read:

Insurance Ethics – One Rule Stands Above Them All


©J&L Risk Management Inc Copyright Notice



James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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