Multistate Workers Comp Claims Adjusting = Challenge

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Multistate Workers Comp Claims Adjusting = Balancing Act

Becoming a Multistate Workers Comp claims adjuster ends up as an eye-opening experience. A recently promoted Senior Claims Adjuster messaged me through LinkedIn earlier this month. The message read (paraphrased) –

My employer (WC carrier) recently promoted me to a remote Senior Adjuster position. For the past seven years, I have adjusted claims in one state.  Now I adjust five states at the same time.  Any advice for me?

My answer –

Congrats on your promotion to Senior Adjuster.  Having a remote position means that your employer trusts you to handle multistate workers comp claims.  In the 80s and 90s, I was responsible for seven states simultaneously.  The states were not regionally located.

My supervisor at the time told me to think of the similarities with multistate workers comp claims – more of a process.  She listed them for me:

  1. The employer files a First Report of Injury
  2. You make a compensability decision
  3. Forms are filed with the state
  4. Benefits are paid until a full return to work unless you issue a denial
  5. Maximum Medical Improvement – MMI attained
  6. Permanency benefits  paid – Forms filed with the state – if applicable
  7. File closed

Yes, even with multistate workers comp claims, the process does not change that much from state to state.  The list could cover 20 points in each state.  The idea was to keep it simple and lower the stress of juggling multiple deadlines under seven sets of different rules.

question mark pic on multistate workers comp claims adjusting
Creative Commons License – Dvdgmz

Some other advice that may assist with multistate claims adjusting

  1.  Your local defense attorney usually will provide an invaluable cheat sheet.  I referred to those until I wore out the paper.  I had 20 pages of the cheat sheets at my fingertips at all times.
  2. If your carrier employer will pay for attending each state’s claims conference, do go to them.
  3. Subscribe to all the claims publications possible.  Many of them charge little or nothing.  At least read the headlines.   Check out the list that I read each week.
  4. Obtain your Associate in Claims designation.  This helps with covering subrogation issues in multistate Workers Comp claims.  The AIC designation makes your CV shine if you wish to move up with your current employer.
  5. Do not send a rapid-response email to anyone – unless it is a critical situation.  Set your email to hold emails for a few minutes to a few hours.   I learned my lesson early on with this one.

Bottom Line on MultiState WC Adjusting

Multistate Workers Comp claims adjusting can be challenging.  Take the assignment from the viewpoint that not all TPAs or carriers trust all their adjusters with more than one jurisdiction.

 

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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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