Injured Employee Contact Debate – How Often?
In our file reviews, one trend we have noticed since the end of the pandemic is the lower level of injured employee contact by the claims adjusters. Could it be the subset of claim files that J&L reviews does not represent claims adjuster contact for all workers comp files?
Yes, but the trend of not contacting unrepresented employees has occurred since I started adjusting WC files long ago – in the mid-1980s. in the old horse and buggy days, an adjuster only had a phone. The days of personal email were just starting with no smartphones.
My claims manager would require us to file injured employee contact logs for review. She felt that the adjusters including me dreaded calling the injured employees. The claims manager was correct. Approximately 1/3 of the injured employees would contact me directly. Those counted on my logs even though I did not initiate the call.
Three-Point Contact Gets The Ball Rolling
Three-point contact (Physician, Employer, Employee) remains a super-critical time for 24-hour contact. Many files I have seen over the years do not have documentation that indicates any injured employee contact. No phone call is made, and a letter is mailed to the injured employee. As my claims manager used to say, “That will be something for the employee’s attorney to read” when they receive it.
In other words, calling the injured employee is a great way to let the employee know that someone is working on the file and their employer has filed all necessary forms timely. I used to dread the first reports of injury (FROI) coming in on Friday afternoon. Many detrimental developments can occur between Friday afternoon and Monday morning without the injured employee being contacted upon receipt of the FROI.
The initial call is a great time to take a recorded statement if necessary. Some carriers and TPAs require recorded statements. Some leave it to the adjuster’s discretion.
Establishing a working relationship with the injured employee at the very beginning usually results in a lower claim value and has a bit of a customer service element to the injured employee and insured.
After The Initial Conversation
I was reviewing a set of files for an agency earlier this year. I noticed one outstanding adjuster for a TPA in Arizona. Matt made the injured employee contact by calling them at least every 21 days. His files closed quickly and for a comparably lower claim value than the other adjusters in the set of files from the same TPA. One area that made him stand out – documentation. He would document the conversations to the nth degree.
Matt also returned any phone calls within 24 hours – even if he had to stay after hours on a Friday to make sure the calls were made and not allowed to fester over the weekend.
Emails are great but the human element is taken out of the equation. We all receive hundreds of spam emails weekly if not daily. The one nice component of emails is self-documentation.
Many carriers and TPAs supplement the injured-employee contact with a login ID and password for the injured employee to follow their claim. If an injured employee can see if a payment was made or treatment was authorized, phone calls and emails are reduced quickly.
If there is nurse triage or a field case manager on the file, an adjuster may not need to contact the employee as often if there is no case management or triage on the file.
Injured Employee Contact No-Goes
One area I have seen in files over the years that should never be broached is talking with represented employees – even to verify that a medical or weekly benefit payment was made on the file. I had made this mistake many years ago. A letter from the employee’s attorney to my claims manager made sure that I never did that again.
The other area is text messaging. I handled a small group of files where I gave the injured employees my personal cell phone number. Most of the files were seriously injured mega claims. Injured employees will text you at 3 AM without hesitation. I learned my lesson quickly.
The Secret Guide For Injured Employee Contact
What document aids all claims adjusters in the area of injured employee contact? Do not tell anyone this secret.
It is called the Claims Processing Manual which all claims’ adjusters are paid to review when they start with a new carrier or TPA. Look up the Employee Contact section. This manual will spell out what the carrier or TPA expects the adjuster to do in the area of contact. Please do not use anything in this article that may be different than what is in the manual.
Even Senior Adjusters should dust off the manual and review it. One can never go wrong with following the instructions in the manual. I have written almost 10 claims processing manuals from scratch that seem to not receive even a glance from the adjuster trainees to the Claims Supervisors.
Knowing your claims handling manual beyond the employee contact instructions will always save you many future headaches. Do not end up like me having my Claims Manager read me a letter from the employee’s attorney.
Notice that I do not call an injured employee a claimant. Yes, they are filing a claim for benefits, but the injured employee or injured worker phrase looks so much better in the file documentation.
2025 Update – This info still works today with emphasis on not providing your own cell number to injured employees. Use the contact numbers in your adjuster profile only.
January 2026 Update – I am not sure that claims adjusters should allow injured employee contact by text. I am going to write an article today on that very subject.
