Adjusting Workers Comp Claims in A New State – Five Mistakes
Adjusting workers comp claims in other states became popular before the pandemic. Many states allow an adjuster to pay a license fee and start adjusting away. In our claims loss run, E-Mod, and file reviews, we have seen five mistakes that keep occurring consistently.
The five mistakes are (listed in order of importance)
- Not being properly licensed in the new state(s). Each state has its list of licensed adjusters/agents and what lines they are licensed to adjust. Make sure your name is on the state list. If not, immediately find out why your name is not on the list. Do not think that if you satisfy your home states requirements that you are automatically satisfying the other states’ requirements.
- Your home state license – once your home state license becomes problematic, so does your license for adjusting workers comp claims in the other states. The educational or CEUs required in your home state seems to be the most prevalent shortfall.
- Not only the rules, but the total environment for adjusting workers comp claims may be different. How you adjust in one state may not work in another. Each state is unto its own with workers compensation even though the forms, deadlines, and benefit payments may be similar. Many defense attorneys can provide you with a cheat sheet of how to handle claims in the new state.
- The WALSH or PWALSH test for claim jurisdiction may cause the claim to be moved to a jurisdiction where you do not possess a license. Check here for the WALSH/PWALSH test to make sure you have the correct license.
- The medical networks that exist in one state may not be the same in other states. This one befuddled me the most when I did full-time workers comp claim adjusting. The employer may have the right to choose an initial treating physician in one state. The employee may have the choice in another. The jurisdictional concern (see #4) can complicate this one even further.
Bottom Line
If you are adjusting workers comp claims for a carrier, you may be provided with a guide on the new states. If that is not the case, many workers comp professionals such as rehabilitation nurses and defense attorney firms may be of great help.
Attending a claims conference in the new state(s) can easily provide most of the knowledge that you need to adjust claims in the state. Check with the insurance department or Workers Comp Commission in the state for the next conference dates.
