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Workers Comp Adjuster Goals Conflict With Management Expectations?


Advocacy Model vs. Workers Comp Adjuster Goals – A Point Missed?

Did I miss The Point  – Maybe? 

I recently attended a webinar provided by the National Workers Comp and Disability Conference where some of the Workers Adjuster goals were compared to the expectations of claims management.

picture of workers comp adjuster goals geophysical survey
Public License – Vadams

Two of my favorite workers comp people, Rachel Fikes of Medical Rising and Denise Zoe Algire of Albertsons Companies led the event.  Those two ladies have always been kind and gracious to me at all times, especially in-person.

I had written multiple articles pleading with adjusters to fill out the surveys to voice the claims staffs’ opinions on what their goals were during the process of a claim.

You can sign up here to listen to the webinar – totally worth it if you are in a claims office or if you have any interactions with workers comp adjusters.

The Survey Says (thanks Richard Dawson)

The shocking part was the congruence (similarity) between claims management expectations and the workers comp adjuster goals.   Slide #6  had the Top Competencies Alignment between management and the claims staff.   You will need to register to listen to a recording of the conference and to obtain the slides, please do listen to it – take the time.

The conversation in the webinar focused on:

•    Alignment of frontline staff perspectives with those of claims leaders surveyed in prior years
•    Assessment of job meaningfulness
•    Ranking of company benefits that frontline staff most value
•    Adequacy of new hire and senior staff training
•    Ranking of core competencies and key practices most critical to claim outcomes – the one I am covering today.
•    Assessment of technology and data’s impact on job performance
•    Understanding of advocacy-based claims models

Frontline Staff Rankings

  1. Compensability Investigations
  2. Disability / RTW Management
  3. Medical Management
  4. Claim Resolution / Settlement Strategy

As one can see, these are the steps to “getting the claim off my list”.  I could possibly be too “old school” in my views, but this is what I always hear from any adjuster that I speak with presently.

If one opens up any workers comp claims manual, the above 4 are major headings in the manual.  The survey was spot-on to ask those questions (good job).

Yes, we all want to make sure the injured worker receives every penny they are owed timely.  Many states are now ratcheting up the investigations and fines for sloppy or late adjuster benefit actions (payment, filing forms, etc.).  The prior link is behind a WorkCompCentral paywall so I cannot share passages from it.

Adjusters want to naturally provide benefits timely.   Some of the state-enacted COVID-19 presumptions made adjusting staffs look like draconian claim deniers – very unfortunate.  Occupational disease statutes have long taken care of claimants when a disease has been contracted on the job.

Did Claims Management And Workers Comp Adjuster Goals Align?

As with any survey, the opportunity to dig deeper exists.  I hope to see the question of Workers Comp Claims management and adjuster goals have a further explanation to it.

Good job – the survey and results production required a ton of hard work.



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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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