Workers Comp Claims Adjusting ASAP – It’s Over in 48 Hours

January 21, 2021 By JL Risk Management Consultants

Workers Comp Claims Adjusting – Do It Now on New Claims

The Workers Comp claims adjusting for new claims is over in 48 hours. I know – sounds like a bold statement. The old paradigm used to be 24 hours. I am giving the adjusters a break.

Many of my webinars and presentations on handling claims by employers and the claims staff always come with a warning. As Roy Orbison sang – It’s over.

roy orbison pic workers comp claims adjusting over 48

Wiki Public Use – Ronzoni

Check out this article on the 48-hour timeclock. Most of the links in this article were written at least 12 years ago.

New Claim Over in 48 Hours – A Timeline

My Six Keys to Saving on Workers Comp follows the same timeline. The steps are:

The employee has an accident. For employers – are injury reporting procedures in place? If not, an expensive delay has already occurred – the adjuster has not seen the claim yet.
The employee reports the accident. Does the employer have procedures for reporting an accident?
The claim is filed. The injured employee seeks out medical treatment. The workers comp claims adjusting process has not started yet. Medical control of the file has already been established by the employer and employee.
The adjuster receives the claim. They contact the employer, treating physician, and injured employee – if the claims staff performs the critical three-point contact.
In #4, the first report of injury may be on the adjuster’s screen after the 48-hour time frame. That is why ASAP remains the best way to obtain and keep control of the claim throughout the process.

The injured employee has reported the claim, sought medical treatment, and may be off work by the time the first report of injury is received by the claims adjuster.

Workers Comp Claims Adjusting vs. First Impressions

Man treating Workers Comp Claims Adjusting an injured person's leg

Wikimedia commons – Public domain

The employee has already interacted with their employer in reporting the claim. The claims clock ticks away.

The important part – the injured employee has already judged the workers’ comp process first-hand. They have already developed a positive or negative attitude by going through the process.

The claim is 48 hours old. Every part of the workers comp claims adjusting process will not really change the claim. First impressions count.

Over the years, I realized why my first claims manager would go ballistic if the three-point contact was not made within 24 hours even if the claim came in on a Friday afternoon.

One saving grace comes from the WCRI (Workers Comp Research Institute) with the studies by Dr. Savych. The one component when looking back on their claim after the resolution was the trust of the employer by the employee.

©J&L Risk Management Inc Copyright Notice

Workers Comp Adjuster Goals Conflict With Management Expectations?

November 12, 2020 By JL Risk Management Consultants

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

Compensability Investigations
Disability / RTW Management
Medical Management
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.

©J&L Risk Management Inc Copyright Notice

Talented Workers Comp Adjuster – Do They Have IT?

July 30, 2020 By JL Risk Management Consultants

The Talented Workers Comp Adjuster – What is IT?

IT Applies To Any Line of Adjusters – Not Just WC

Many discussions on a talented workers comp adjuster (or any insurance line) begin something similar to this. Wow, we are searching everywhere for talented adjusters.

sight guide talented workers comp adjuster

Wikimedia Commons – Usper

I have attended many conferences where the presenters were worried about “brain and experience drain” not being replaced in the areas of safety, risk management, and especially claims.

One presentation that stayed with me over the year came from the NWCDC Annual Conference session. The session consisted of one presenter with a moderator. The presenter worked in HR for a midwestern regional carrier. She delved into millennials and their psychological wants and needs. The presentation was interesting. The one-hour speech left out one thing – IT.

IT is not information technology.

IT and the Talented Workers Comp Adjuster

What does this talent consist of and how do you know if the adjuster is going to make it in a very challenging field?

Many years ago, when I worked with Lumbermen’s Underwriting Alliance (now defunct) in Boca Raton, FL, a sage experienced claims person (Irv Wicknick) presented three one-half day seminars on claims adjusting tips and traps.

The Claims VP and Mr. Wicknick both said that IT was what made an adjuster stand out in a somewhat crowded field. Thirty attendees brought up such attributes such as:

Timeliness
Attention to detail
Empathy
Follow-through
Investigative ability
Willing to work long hours and possibly weekends
And many others

IT = The Talent to Adjust

Most commonly talented workers comp adjuster is IT

Wikimedia Common – HSGTalents

Strikingly and memorably – Mr. Wicknick wrote IT on the presentation chalkboard. He wrote nothing under it or beside the acronym just IT as representing the talented workers comp adjuster.

Irv wrote IT is IT. For an intense half-hour, all the attendees (adjuster trainees up to Claims Managers) asked what is IT? We were told you will know IT when you see IT. No definitions or attributes were given to the group on what was IT other than without IT, most adjusters will struggle with the normal heavy workload.

You can see here the most common duties of an adjuster.

Undefined IT

Over the last 30 years since I heard that term, I always tried to look for IT when I moved up through the ranks and now as a consultant. You cannot:

Train IT
Work longer hours to get IT
Memorize your claims manual to have IT
Further your education to acquire IT – this one possibly moves you closer to IT
Attain it through experience – you can hone IT with experience.

IT vs. Talented Workers Comp Adjuster

I have reviewed policies, claims, and the adjuster’s handy work on over 10,000 files, closer to 20,000. I see IT in some files – usually the same adjusters.

IT to me means “the ability to adjust and expeditiously close out files to the satisfaction of all parties involved in a claim.” The term “all parties” covers many people and organizations in every claim – not a simple task.

One Little Secret

IT or a talented workers comp adjuster can do workload

Wikimedia Commons – Colin

The one attribute to all adjusters in all lines of insurance is file documentation. Being able to pick up a file and understand where it has been; where it is now; and where it is headed in a short amount of time remains the best way to give off “a good first impression.” IT starts with a good first impression. Two to three-line statutes look great in a file.

Caveat – over-documentation can cause the time management abilities of an adjuster to suffer greatly. If one piles on the documentation, when can anything else be accomplished on the file?

Always consult your claims manual – one of those IT things with a talented workers comp adjuster.

©J&L Risk Management Inc Copyright Notice

How To Ruin A Workers Comp Claim in Five Seconds, Claim Number?

June 17, 2020 By JL Risk Management Consultants

Asking For Claim Numbers Can Wreck Any Workers Comp Relationship – J&L

Yesterday, I was trying to locate a claim for a long-term client. I was following the subrogation status on a claim for them. I was told that I had left out one number in a 22-character claim number.

pay phone booth workers comp claim number

Wikimedia Commons-Chriistina Helmsman

The claim was not showing up on a loss run the client ran for me to review. This situation harkens me back to what I have not done in Workers Compensation for 30+ years.

Why I Never Ask For Or Reference Claim Number – A Little Secret

When an injured employee calls in, asking for a claim number does one thing – it reminds the caller or emailer that they are a number, not an individual. In 30 years, I have not looked up any injured employee by a claim number – never, ever.

Injured employees with resolved claims were interviewed by WCRI for a study they were conducting. Dr. Savych produced a landmark study on what happens to injured employees post-claim.

One word came up that determined whether an employee felt the claims process went well. That word was “trust.” If the employee trusted their employer before the accident, claims usually resolved more quickly.

Asking for a workers’ comp claims number may be a great way to pull up a claim. I have always looked up the injured employee by:

Name
Date of birth
Employer
Accident Date.

I never used the claim number. I thought that it impersonalized a somewhat personal transaction.

An Example of Claim Number Alienation

Wikimedia Commons – Oregon Department of Transportation

Approximately eight years ago, I, unfortunately, ran into a deer while traveling at 65 miles per hour. Calling in a claim to my auto insurer at midnight from a hotel room was beyond stressful.

After going through the usual phoned-in claims reporting question, the adjuster gave me a long claim number that I did not write down accurately.

The next morning, I called back in to see about obtaining a rental car. My auto insurance carrier phone rep asked for the claim number. I, due to stress, and sleeplessness misplaced the claim number.

The phone rep kept asking for it. I said that I have my policy number on my proof of insurance. or could he/she not look it up by my name and date of the accident? After 15 minutes of waiting, they came back on the phone with my 20+ digit and letter claim number. I was told it was critical to use that number when calling in after then.

I never called the company again and switched auto carriers at the next renewal.

Bottom Line – I felt like just another number – not really a personal interaction.

Best Way To Find a Person’s Claim

Wikimedia Commons – U.S. Army Europe Images

Pulling up the claim by the injured employee’s name and the employer was always the best way for me. I did not ask them for something that the carrier or TPA had given them to remember and reference. I always asked for info that existed before the claim, not after.

The great adjusters and claim reps seem to always develop some time of personal relationship with the injured employee unless of course if they were represented by an attorney.

Did you ever notice when you deal with a doctor’s office, they do not ask you for a patient number? I wonder why?

Bottom Line – This advice may seem a little picky. Try it and you will see how it changes your relationships with your injured employees. Avoid asking for claim numbers.

©J&L Risk Management Inc Copyright Notice

COVID Compensability Conundrum – Who’s Covering What?

April 14, 2020 By JL Risk Management Consultants

COVID Compensability Conundrum – Coronavirus Causing Workers Comp Claims?

Adjusters Will Deal With COVID Claims

The COVID Compensability Conundrum will arrive later this year when workers comp claims adjusters have to make difficult and complicated claim decisions.

NCCI COVID Compensability Conundrum-19 Rotovirus simulation

Wikimedia – See previous author info

Most states have a disease statute. Not many states include personal sensitivity claims in their rules and regulations.

One of the most prevalent difficult workers’ compensation claims decisions involves the adjuster determining whether or not the alleged work comp injury or disease came from a source that exposed the claimant to a higher degree of susceptibility than just being in the general public.

This type of claim causes much consternation between the adjuster and the injured employee when the file is denied due to the exposure not being more at work than the claimant would find in the general public.

A cold or the flu was never accepted by any claims department that I am familiar with regardless of the job title.

Many members of the worker’s comp press published articles over the last three weeks pertaining to First Responder coverage. Governors are likely to order coverage for First Responders.

Exposed Workers

How about these workers:

Nurse adjusting COVID Compensability mask

StockUnlimited

Grocery store workers
Grocery delivery
Pharmacy staff
Bank staff – handling cash
Restaurant employees – drive-thru or takeout
Post office
Shipping services – UPS, FedEx
Home care workers

As one can see, the list goes on and on. Determining where the exposure occurred is complicated at best.

The adjuster’s job will become even more difficult. How would an adjuster make this COVID Compensability Conundrum decision have more fortitude?

Adjuster Investigation on COVID Compensability

The five main investigative tools for adjusters are:

Job Description – did their job expose the claimant more to COVID than being in the general public? Is there really a general public now with the lockdown orders?
Recorded interview – #1 above should be covered very well here
Treating Doctor’s notes – the person has to have a COVID diagnosis – did the physician relate it into the job – extremely important.
First Report of Injury – an often overlooked investigative tool
Initial discussion with the employer – for obvious reasons

Do not be surprised if the Governors /Insurance Commissioners create orders to pay for COVID work comp claims

As we all sit home and wait to go back to the office, or work harder telecommuting – I thought this quick article on the COVID Compensability Conundrum would cause claims departments to start thinking about these types of claims as more people are tested over the next few weeks.

©J&L Risk Management Inc Copyright Notice

Frontline Adjusters vs. C-Level Claims Mgmt – Great Rising Medical Survey

December 19, 2019 By JL Risk Management Consultants

Frontline Adjusters Surveyed by Rising Medical Solutions – Free Copy of Results

Rising Medical Solutions surveyed frontline adjusters, and other personnel had their turn at the mic last year. Rising invited any frontline claims personnel to take their survey last year.

pic smartphone survey frontline adjusters questions

Wikimedia Commons – AxBest

I added in an article pleading with adjusters and their support personnel to have a say versus the C-Level Claims and Risk Management personnel.

As I moved up the claims department ladder, I became distant from what was occurring at the claims desks. If you have ever read the Peter Principle, you already know this occurs in every organization.

Rachel Fikes and Rising Medical Solutions out of Chicago, IL, invited me to a one-day think-tank with mostly C-Level claims administrators. The day was an interesting take on how the upper claims echelon views adjusting and processing claims. The meeting was an eye-opener.

Their recent press release includes a link to receive a freebies copy of the survey results. Admittedly, I have not read it yet, but I will over the Holidays.

The talent crisis remains a huge concern. Claims and Risk Management departments are aging. Where will the replacements come from in 2025 and further into the future?

Annual Work Comp Benchmark Study Releases 2019 Report Comparing Claims Leader & Frontline Staff Perspectives

FRONTLINE POLLING IDENTIFIES OPPORTUNITIES TO INCREASE ALIGNMENT, CONTEND WITH TALENT CRISIS

Chicago, IL – December 17, 2019 – With an estimated 140.3 million U.S. workers receiving workers’ compensation benefits, frontline claims professionals are personally responsible for managing a total economic outlay of nearly $100 billion dollars in benefits paid annually. Coupled with the industry’s talent crisis – with an imminent mass exodus of retiring claims professionals and challenges attracting young professionals – the impact that frontline staff have on the industry’s financial viability and injured worker outcomes cannot be overstated.

Now in its seventh year, the Workers’ Compensation Benchmarking Study – for the first time ever – surveyed 1,282 members of this critical talent constituency to ascertain how their views mirror or differ from the 1,800-plus claims leaders who participated in prior research. Reprising questions from past surveys, the 2019 Report not only provides recommendations to improve overall operational performance, it also provides strategies for how to best incentivize and retain the frontline talent pool.

“We’ve got a ‘perfect storm’ threatening the workers’ compensation industry right now,” says Rachel Fikes, chief experience officer and study program director at Rising Medical Solutions. “Frontline claims professionals are the largest and most influential employee population in our industry, yet, very little research has been conducted with them to date. Adding frontline intelligence to the study’s cumulative data can help organizations advance claims management and talent practices, as well as confront the increasing stakes of attracting young professionals to our industry.”

The 2019 Report examines frontline perspectives on topics such as:

Ranking of core competencies most critical to claim outcomes
Claims functions that frontline staff spend the most time on
Effectiveness of systems / tools in managing best practices
Assessment of job meaningfulness
Investment in new hire and senior staff training, and whether it’s considered adequate
Ranking of company benefits that frontline staff most value
Understanding of advocacy-based claims models
Assessment of technology and data’s effectiveness in performing current job
Views of technology delineated by years of claims adjusting experience
Usage rates of various analytic programs
Ranking of medical management training, and whether it’s deemed adequate
Ranking of the most important provider quality measures

As in prior years, the 2019 Report will be available to all without cost or obligation as a contribution to the workers’ compensation industry. The 2019 Report may be requested here.

Please only request the report through the link. It is a free report. If the results do not look like what you would have responded, Rising Medical had the survey open for months in 2018 with invitations to all frontline adjusters and claims personnel to respond and register their opinions. If they decide to re-survey claims personnel, then jump on board and fill out the survey.

Great job Rachel and Rising Medical!

©J&L Risk Management Inc Copyright Notice

A Work Comp Claims Department and Chernobyl – One Major Similarity

June 20, 2019 By JL Risk Management Consultants

Work Comp Claims Department and Chernobyl – Manuals Will Not Fix The Problem

picture work comp claims department chernobyl

Wikimedia Commons – Public Use License

How does a Work Comp Claims Department and Chernobyl end up in the same passage?

The article title originates from an extremely highly lauded book – Midnight in Chernobyl. The author’s breadth and depth of what occurred will astound any reader. I cannot recommend the book enough if you want to know what really happened at the greatest nuclear disaster on earth.

How does the affable claims department receive such a comparison? One of the passages in the book jumped off the page.

From page 68 of the book-

the atomic chieftains of NIKIET and the Kurchatov Institute apparently believed that a well-written set of manuals would be enough to guarantee nuclear safety. The designers assumed that, so long as they followed the new instructions closely, human beings would act as promptly and unfailingly as any of the plant’s electromechanical safety systems.

Picture of nuclear power plant work comp claims department in Germany

wikimedia.org – Heinz-Josef Lücking

But the staff of Soviet nuclear power plants, faced with ever-increasing production targets and constantly malfunctioning or inadequate equipment, and answerable to a bewildering and dysfunctional bureaucracy, had long become accustomed to bending or ignoring the rules in order to get their work done. And the updated instructions they received from NIKIET were neither explicit nor explained.

One of the new directives stipulated that a minimum number of control rods should henceforth be maintained within the core at all times—but NIKIET did not emphasize that this limit on the operational reactivity margin, or ORM, was a crucial safety precaution intended to prevent a major accident. Deprived of information about why such rules might be important, the operators went on with their work as usual, ignorant of the potentially catastrophic consequences of breaching them.

Any department in any company may possibly function like the NIKIET. However, the manuals that I read the most over my career were claims manuals. I designed, evaluated, and corrected many claims manuals over the years. I recommend reading the passage very carefully as this appeared just before the accident

Performing claims audit – with the viewpoint of former adjusters, supervisors, managers, and VP;s – remains one of our most requested services. The first document any reviewer, auditor, or claims analyst asks for is the manual. Why?

Magnifying glass work comp claims department on audit paper

Wikimedia – Public Use

The claims manual supposedly directs the work comp claims department how to process and adjust claims in that certain company. The manuals can be expansive or a few pages. Whenever any self-insured employer asks about how their claims are handled, I suggest asking for a copy of the Third Party Administrator’s (TPA) claims manual. Some TPA’s work comp claims departments are not that forthcoming with divulging their operations manual.

Some TPA’s admitted they had no claims manual. A few even asked me to write one for them. Nowadays, that request seldom occurs due to the ability to compose a claims manual using online assistance. If a work comp claims department does not cover a certain subject, one needs to refer to the industry standard.

I try not to be so critical of claims departments as some of my fellow blog article producers. After riding the adjuster seat for many years, the critic task seems easy to do in most cases.

The last bolded passage causes much chagrin in work comp claims department. Teaching the work comp claims department why their operating manual is so important may be an on overlooked task that may cause a claims disaster.

One of my largest concerns that relates to claims manuals arises when I periodically review a certain set of claims. For instance, I reviewed the claims processes three years ago (i.e. June 20, 2016). I look at the electronic manual’s computer file data that says something like:

File created February 1, 2010
File last updated June 20, 2016

You can find that info on any computer file. This file notation meant that last time any update to the claims manual occurred three years ago when I updated it during a claims review or the carrier/TPA had hired me to update the manual.

My recommendation remains that each section of a claims manual should be taught for at least an hour per month by the senior adjusting, supervisory and managerial staff of the work comp claims department.

©J&L Risk Management Inc Copyright Notice

Work Comp Claims Adjuster Survey – Finally – Your Opinion Matters

June 19, 2019 By JL Risk Management Consultants

Register Your Opinion Anonymously – National Work Comp Claims Adjusters Survey

The Work Comp Claims Adjusters seem to be the quiet majority (Orwell 1984 reference) of most insurance companies and Third Party Administrators.

picture of work comp claims adjusters mars surveyor

Mars Surveyor – NASA

Any person that works in the worker’s comp claims arena knows that sometimes they are completely left out of any decisions and rarely (like never) asked their opinions on anything. Many articles on studies appear in this blog with the theme – Hey, did they ask a claims person before publishing this study?

Your chance to register your opinion comes around rarely. Rising Medical (Chicago Bill Review-Rehab Nurses-other services) provided any adjuster with a chance to have their say in the process. Rising Medical will then compare the answers by the claims staff to the Executives.

Working my way up through the Work Comp adjuster ranks to a VP level, I can attest that the Claims Executives can easily become out of touch with the front-line workers, as in most companies.

The only drawback that I see in this process is that claims workers did not have a hand in designing the study. I could be wrong on that point, as I am only referencing the press release.

Rising Medical kind of “gets” the worker’s comp claims staff’s challenges. Check out this video if you are having a bad claims day.

From Rising Medical:

Picture of medical work comp claims adjuster volunteer

wikimedia – Mstyslav Chernov

The Workers’ Compensation Benchmarking Study’s annual survey is underway. Now in its seventh year, the 2019 study will – for the first time ever – survey frontline claims professionals (instead of claims executives) to ascertain alignment between industry leadership and staff who directly handle workers’ compensation claims. As the industry’s largest talent constituency, with the greatest influence on financial and injured worker outcomes, visibility into how their views mirror or differ from claims executives will highlight opportunities to advance the entire industry.

The 2019 confidential survey will continue throughout May. All frontline participants and study stakeholders will receive a copy of the 2019 Study Report which can be used to validate operational alignment, verify existing strategies, advocate for resources in support-challenged areas, and identify opportunities to impact claim outcomes. Claims executives are encouraged to share the survey link with their frontline teams as an investment in this industrywide effort.

The Workers’ Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers’ compensation today. The study’s mission is to advance claims management in the industry by providing both quantitative and qualitative data. Through survey research with claims leaders and practitioners nationwide, the program generates actionable intelligence for claims organizations to evaluate priorities, challenges, and strategies amongst their peers.

You will receive a copy of the study for your time. I call this one a deal. Do not procrastinate. The survey may close out soon. Work Comp claims adjusters – have your say.

©J&L Risk Management Inc Copyright Notice

National Adjuster License For Workers Comp Quite Challenging

November 2, 2018 By JL Risk Management Consultants

National Adjuster License vs. Reciprocal Exchange Agreements

The subject of national adjuster licenses created quite a bit of buzz. WorkCompCentral published an article on this very subject a few weeks ago.

California was moving towards the national adjuster license standard. I then read on into the article.

map of striped national adjusters license usa

Wikimedia license – Leo Chapin III

The national adjuster license seemed to be more of a certification process administered by an organization referred to as CLM (Claims and Litigation Management Alliance).

Five states signed onto the UCC (Universal Claims Certification) process: Florida, Texas, Georgia, Alabama, and Mississippi. The licensing requirement of the UCC will be more stringent than a state-based licensing program.

The UCC is not meant to replace an adjusters license. The UCC would streamline the process. Various versions of a Bill to advance a national adjuster license standard has died in Congress.

From the CLM website:

The process of licensing independent and staff insurance adjusters has been unnecessarily complex for decades. Most adjusters handle claims in multiple states and are burdened with maintaining multiple licenses and tracking the different renewal criteria for each license. The current system also limits the flexibility needed when a natural disaster occurs and a large number of adjusters are needed promptly in a specific state. Many qualified adjusters are unable to assist in these situations until they can go through that state’s licensing process.

This concept looks like a great idea. I am not sure if it would work for workers compensation adjusters. As an all lines adjuster in 12 states and a consultant in the other 38, some issues would have to be addressed with a workers compensation national adjuster license.

Specificity

Many lines of insurance adjusting do not change that much when a state line is crossed concerning a claim. An adjuster from Minnesota handled my loss from Hurricane Michael. He did a great job – very professional.

One of the main characteristics of multi-jurisdictional workers compensation claims is when adjusting a claim in another state, a whole new pile of laws and rules come into play.

A workers compensation adjuster always has two governing bodies over their claims, not just one. The Industrial Commission (Workers Comp Board) and the respective Department of Insurance in that state.

At one time I juggled 7 states in my adjusting career simultaneously. That was a challenging, yet at times, confusing task.

One Standard

What would one standard look like for all workers compensation adjusters in every state? Would 40 hours of education actually cover enough to update the adjuster’s knowledge to begin immediately adjusting claims in a new state overnight?

ACORD Form 4 started to become a nationalized form for reporting injuries. The form covers most incident reporting situations very well. A few states still accept the form. This form was my first exposure to a nationalized workers compensation form of any type. The form came with five pages of instructions.

Reciprocal Exchange

The reciprocal exchange environment can be confusing. I count myself fortunate as all the states I have ever applied to as an out-of-state adjuster accepted the hours that I had earned for my resident state license as appropriate for their respective state.

A national adjuster license may save confusion when it comes to the time of renewal. Remembering what license renewal was required on what date caused me to have to completely re-apply to one state. The only detriment was the extra fees when the license lapsed.

Final Thoughts

The idea of a national adjuster license remains a great idea. The Institutes (think CPCU, ARM, etc.) bought the website and program from its creator. This article was not to say the idea was unworkable. The task will be a challenge to administer a national adjuster license for workers compensation.

©J&L Risk Management Inc Copyright Notice

Workers Comp Automation Can Replace Claims Adjusters

December 21, 2017 By JL Risk Management Consultants

Workers Comp Automation – Can A Claims Adjuster Be Replaced?

Workers Comp automation on reserving, payments, diaries, etc. has been discussed for at least 20 years. In fact, an article I wrote over 10 years ago covered the accuracy of automated reserving software. I had forgotten the article in 2007. I covered automated reserves again in 2009.

picture of workers comp automation computer CPU

Public License Binary Sequence

The post in 2007 was the first one in this blog to actually go what some would consider viral.

The article title possibly should have included a question mark at the end. However, there are factions of people that think Workers Comp claims adjusters could be replaced with software – yes, software packages.

Let us look at the Top 13 duties of a claims adjuster to see if they can be replaced by workers comp automation over the next few years. They are:

1. Investigate claims within 24 – 48 hours after receipt of the First Report of Injury. – This task could not be automated whatsoever as human intervention would be required. The only automation here is basically already in place. The supervisor can track what of the three-point contact the adjuster performed timely. The claims adjuster can track what duties they have performed on which claims.

2. Provide benefits to injured employees. I would have to give this one to automation – except someone has to input the proper amounts into the software – that being the claims adjuster.

3. File proper forms with State WC Board. This has to be one of the more automated tasks I have seen lately. As with #2, someone has to input the proper amounts and data into the software to make sure the right information is filed with the respective state’s Workers Compensation Board. Automation can help with making sure the forms are filed timely.

4. Set initial reserves on new claims and review reserves on established claims (usually for increases). This area creates more hotly debated items than almost anything in claims adjusting. Check the two links in the first paragraph. I ran into a state fund that was using automated reserving software at the time. The results were far off from what I had expected for the file reserves.

2019 update – Please note that claims analytics still cannot automatically set accurate reserves. I have reviewed sackfuls of software at conferences that claim to assess reserves properly. If someone has come across a good auto-reserving system, please contact me.

nursing of workers comp automation have a rehabilitation center

Wikimedia Commons by satish23reddy

5. Pay bills on claims (medical, rehabilitation, defense attorney). This task can somewhat involve Workers Comp Automation, The claims adjuster still needs to review the bills to make sure they are appropriate for payment. Automated payments should still have the adjusters making sure the payments are justified before releasing the funds.

6. Settling claims. Someone at a booth in a big conference showed me software that could estimate the amount recommended for settlements. I asked 20 – 30 questions about how can the software know the adjuster – claimant relationship (which is very important). Presentation over. I guess I should have just sat there. Oh, well.

7. General clerical functions. This one has to go with workers comp automation. A large portion, not all, of the claims administrative functions can be automated with the proper software/apps. I have seen many posers whose software was not great in this area. Others were better than great.

8. Completion of periodic claims status reporting to insureds, carriers and/or reinsurers Loss run automation by carriers and TPA’s have improved this area over the last 10 – 20 years. As with most automated tasks, the adjuster still has to input the data required to complete these types of reports.

9. Maintaining up-to-date file documentation of any development on the claim including phone calls, correspondence received and sent, review of medical notes, etc. The Workers Comp automation involved is very limited. The adjuster has to add the documentation into the file. The automated processes here would be scanning in some of the documents.

Please note – emailing is a huge help to the claims adjusters and to any outside parties including the employer. The sender and claims department recipient will both have a document that can be added to any notes system. A phone call means the adjuster and caller have to input the conversation into the notes for documentation purposes = double work.

10. Minimum of monthly reviews of the claims (via diaries) to assure claim is proceeding accordingly toward closure. Maintain and update periodic action plans to move the claims toward closure. The theme of this duty concerns pushing the file to closure ASAP. Once again, workers comp automation enables the adjuster to have assistance from diaries on when to perform the reviews. Unless I am mistaken, there exists no software that can perform this critical function.

Action plans could be derived from the claim notes and statutes. Once again, the claims adjuster has to input the action plan information. The automated processes would provide a due date for the action plans.

11. Authorize and schedule medical appointments for the injured employees and follow up for receipt of medical documentation including work status reports. AI could possibly schedule and authorize medical appointments and possibly check the incoming medical report scans for work status reports if the reports from the medical providers were heavily structured.

One again, the timing of these tasks could be helped greatly by automation. The actual tasks would be accomplished by the claims adjuster or the support staff.

12. Follow up with employers to determine if work is available for the injured employee (limited duty or full duty) and/or assign vocational rehabilitation to assist the claimant in finding alternative work to lessen exposure.

As with many of the listed adjuster tasks, automation would assist the adjuster, not replace them totally. Automation could assign the vocational expert by region or type of employment.

13. Review files for reserve reductions or closings.

A few carriers and TPA’s automated this task for medical-only claims. If after some time period passes, with no activity, the medical only claim closes itself out. I have seen very few problems with this scenario other than clams festering.

An adjuster rarely reduces the outstanding reserves on a file unless the file closes. Workers’ comp automation cannot reduce the reserves without adjuster input. Once again, the reserve reduction time could be aided by the system flagging those claims. However, how does the system know how much to reduce claim reserves?

Automation = Adjuster Aide Not A Replacement

Above is the largest article I have ever written for this blog. Each task’s automation shows that AI can enhance a claims adjuster’s performance. However, at this time, automation cannot replace any adjusters.

Please excuse any grammatical mistakes – I did not have time to review it before releasing it.

In the future, I may change some of these tasks aided by workers comp automation.

2019 Update

None of the above 13 tasks have replaced any of the adjusters yet. The Provide Benefits task helps the adjuster but does not replace him/her. The technology of the 1990’s aids claims adjusters in their daily tasks. Allowing access to bill payments and benefit payments have reduced the need for so many phone calls. Adjusters have not yet fallen victim to worker’s comp automation.

2020 Update

Claims analytics discussions happen often in the Workers Comp world yet today. This area of workers comp automation still falls short.

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Work Comp Adjusters – Settlement And Reserve Authority From Insureds

June 21, 2016 By JL Risk Management Consultants

Work Comp Adjusters – A Controversial Subject

Most Work Comp adjusters have a very strict authority level in the internal working of a claims department. The subject of having to receive authority from the employer/insureds can often be an exercise in frustration.

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The previous blog article that I had written on this subject generated many questions by work comp claim adjusters and employers.

The claims adjuster trainees, claim adjuster, senior claims adjuster, supervisor, manager and Vice President all have an increased authority level for settlements and/or reserves. The adjuster may have to hold six or seven meetings just to have the reserves or settlements approved internally.

Certain employers may request a type of special claims handling on a file. This results in the adjuster after having several meetings internally to hold a meeting with a person or persons that may not completely understand the Workers Comp process.

Technology has eliminated many of the adjusters’ concerns that they may not know the level of when an employer is to be contacted before a settlement offer is made or large reserves are pending. The claims department’s computer system may not allow the settlement offer or large reserves without having internal approval.

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More than a few work comp adjusters are concerned they may increase the reserve levels or initiate a settlement offer without an employer’s approval. The adjuster very rarely handles files for one or two employers. Some systems will advise the adjuster to contact the employer when a reserve or settlement offer (for instance) is over $100,000.

I have actually seen an employer contact request when any reserve, compensation payment, or medical bill was more than $5,000. The adjuster(s) spent more time asking for employer authority which made the file handling for that employer suffer over time.

There is a delicate balancing act on requesting that an adjuster make contact with a settlement or reserve authority request and not interfering with the 13 daily responsibilities of work comp adjusters.

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Workers Comp Adjusters – Feel Good Friday

April 1, 2016 By JL Risk Management Consultants

Video By Rising Medical Solutions Is A Pick-Me-Up For Workers Comp Adjusters

Unfortunately, Workers Comp adjusters have been and will always face the brunt of the WC process. I have often defended adjusters and the whole WC system against the likes of ProPublica and the general click-bait WC environment – that is what we call social media of today. The environment has gone for the lowest common denominator – the sometimes fallible WC insurance claims system.

Picture Of Doctor Workers Comp Adjusters Holding Files

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I usually only read the opinions on claims originating from a person that has served some capacity in the WC claims side. In other words, you have to ride in that saddle before you can talk about the horse.

The video is three+ years old. Rachel Fikes and her group put together as simple video. Simple is good in most instances. I first met everyone from Rising last May at a WC think-tank in Chicago. They were a good group of people. That was my first time for an extended stay in vibrant yet eclectic Chicago.

Rising Medical Solutions did not pay me any incentive for running their video. Great marketing is indirect marketing. The video is about Workers Comp adjusters and, in fact, the whole claims staff, and their valuable worth in the claims process.

So here is the link to the video – in fact, it has its own website. Click here for the video. Make sure you have the sound on for the full effect.

Sip your coffee or other beverage and enjoy.

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Top 10 Industry Gender Pay Gaps – Double Shocker 2 Insurance Related

July 3, 2014 By JL Risk Management Consultants

Top 10 Industry Gender Pay Gaps – Two Insurance Related (?)

Any gender pay gaps should be a concern to that industry.

Another holiday is upon us. I had already written two articles this week. I decided to Google what other subjects to write about just before a holiday. One of the best online newspapers on earth is the Daily Mail out of the UK. The Daily Mail provides an outsider’s objective view to what is happening in the US.

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I came across this shocking article on gender pay gaps. Even though the article was over six months old, it was still relevant. The original article from another publication can be found here. The original article – a great analysis delves much more into the gender pay gap.

The industry with the highest gender pay gaps was Insurance Agents along with the #10 rated industry as Claims Adjusters and Examiners.

Female insurance agents made less than 2/3 of their male counterparts. The number of female vs. male workers in this area are basically the same.

Women claims adjusters/examiners made less than 70% of their male counterparts even though as of 2012, women held nearly two thirds of the jobs in these professions.

I, or the articles, did not explore the reason for the gender pay gaps. The full list is enumerated below.

1. Insurance

Women’s wage as pct. of men’s: 62.5%

2. Retail

Women’s wages as pct. of men’s: 64.3%

3. Real estate brokers and sales agents

Women’s wages as pct. of men’s: 66.0%

Man And Woman Gender Pay Gaps Arm Wrestling

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4. Personal financial advisors

Women’s wages as pct. of men’s: 66.3%

5. Education administrators

Women’s wages as pct. of men’s: 67.2%

6. Physicians and surgeons

Women’s wages as pct. of men’s: 67.6%

7. Marketing and sales managers

Women’s wages as pct. of men’s: 67.7%

8. Security, commodities and financial services sales agents

Women’s wages as pct. of men’s: 69.1%

9. Inspectors, testers, sorters, samplers and weighers

Women’s wages as pct. of men’s: 69.2%

10. Claims adjusters, appraisers, examiners and investigators

Women’s wages as pct. of men’s: 69.3%

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Workers Compensation Predictive Modeling Will Never Work

November 8, 2013 By JL Risk Management Consultants

Workers Compensation Predictive Modeling

One of the more popular buzz phrases now is Workers Compensation predictive modeling. If one looks at any of the WC groups on LinkedIn, there are many discussions on this very matter.

Wikimedia – Jaberi-Douraki M

There are many predictive models on WC. Those models usually leave the observer with an empty feeling. Yes, you can forecast the Indemnity and Expenses almost to the penny. There are many modeling programs that will suffice in this case.

The inherent problem is valuing and forecasting medical benefits on any file. A health profile and background of the injured employee may shed some light on the subject. However, we are all very genetically unique individuals.

Woman Workers Compensation Predictive Modeling Carrying Files

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A ruptured spinal disc can vary in treatment from two months to two years or longer.Predictive modeling requires some sort of stability in the variables. As any adjuster will tell you, it is hellish to try to predict medical treatment at the outset of the file. There are medical outcome determining factors that are not known for many months.Workers compensation claims adjusters walk a very fine line with medical forecasting. Sixty days into the file development, the adjuster is supposed to make a medical reserve determination for the life of the file. This is not possible. Reserving files is an art, not a science. We analyze many reserves on files on a daily basis. Reviewing reserves is a complete exercise of hindsight which is usually 20-20. Discussing what reserves were placed on a file one or two years ago is an easy task. The reverse of discussing what the reserves should be on a file in one or two years is difficult at best.Communicating with the claims adjusters about the status of an employee can reap large dividends, but as they happen, not three months later. Emails work best for claims departments.

Bottom line – a well-trained experienced adjuster is the best predictive modeler in Workers Compensation.

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Scariest Claims of All – IBNR Can Be Frightening – Happy Halloween

October 31, 2013 By JL Risk Management Consultants

IBNR Can Be Frightening To All Parties

IBNR (Incurred But Not Reported) can be one of the most frightening aspects of the Workers Compensation system as a whole. I often hear the term bandied about in WC “techie talk” conversations. All parties in the WC system need to be aware of these claims.

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I used to ignore the term as just being another term that confuses people. I had thought it was not important enough to mention very often when this blog was started in 2007.

The definition of IBNR claims is basically claims that have occurred which have never been reported to an employer or carrier. How does this affect each entity in the WC process?

Employers

Injuries such as carpal tunnel; a worker’s back that has been strained several times; a trucker that has to haul loads on a very dangerous route, can all be thought of as a claim “that is waiting to happen.” The even scarier ones are where the employee decides to “work through” the injury. The accident has occurred but the employee just does not report it to their employer. Employers usually find out about these claims when there is a layoff or the person no longer works for that employer.

Carriers/TPA’s

Many formulas (regression, triangulation, etc.) have tried to assist in assessing how many claims a carrier or TPA does not have that are “not on the books” such as the prior example where an employee has not reported the claim to their employer. The other conundrum for carriers/TPA’s is when the employer decides to pay small claims and not report them to their carrier. This violates one of the Five Keys To Saving on Workers Comp Claims that I wrote many years ago. I coined the term “claims festering.” This is a claim that has occurred and was reported to the employer, but not reported to the carrier.

Rating Bureaus, State Regulators

House On Top Of Roll Money IBNR And Man Sitting On Chair

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These two groups have been left to rectify and quantify the IBNR claims. There is a very large amount of reference data in existence. However, trying to assess something that does not yet actually “show in the numbers” is a tough task at best.

IBENR

This is a term that leaves actuaries, insurance carriers, rating bureaus, and regulators scratching their heads. Incurred But Not Enough Reported (IBENR) will add adjusters to the mix. A claim may have been reported, but not yet reserved properly. IBENR really can be affected at all levels of the WC insurance process. I actually accidentally found this term when I googled IBNR.

The bottom line is to watch out for IBNR – better known as the claims goblins.

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Settlement Authority – Should Adjuster Ask Insured?

August 26, 2013 By JL Risk Management Consultants

Settlement Authority Should Be In TPA Contracts or Policies

When should the adjuster settlement authority be approved by the insured? One of the most repeated comments we hear when reviewing claims loss runs is an adjuster settled or agreed to accept a file without the insured agreeing to the settlement. We often hear that an adjuster increased the reserves to a very high level without consulting the employer.

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Almost all insurance and TPA policies for Workers Comp coverage will have a clause in it that reads something akin to:

We have the right to reserve and settle files as we deem necessary.

That is not necessarily the exact language. However, if you pull out any policy, be it auto, liability, Workers Comp, etc. the clause is included somewhere in the text. The settlement part of the clause usually refers to some third party. In this case, it is the injured worker.

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The best way to avoid any loss run surprises IS AT CONTRACT SIGNING TIME. Many larger employers, especially in a TPA environment, will ask that if the file reserves reach, for example, $100,000, the reserve increase and all subsequent ones to the file are only entered into the TPA’s system with written approval from the insured.

A similar limit can also be instituted for any settlements, of say, over $50,000. This notice is very critical for TPA’s working with a self-insured.

Some carriers will also make sure the adjuster receives employer permission to settle or make a large file reserve increase. However, the service is usually an expensive cost add-on in quite a few WC policies.

If the carrier or TPA agrees to insured pre-authorization, the reserve or settlement limit should not be set too low. I have seen authority levels at $10,000. The adjuster tends to spend so much time on making sure they have the proper authority with such low levels that they are handcuffed in their ability to handle the file.

Most claims adjusters also have to have the proper company internal authority. Turning the adjuster into an authority-seeker takes them away from their main job tasks.

One of the reasons to have the adjuster ask for settlement and reserve authority is to avoid violating reinsurance contracts. Most reinsurers want to hear from someone when a file reaches, for instance, 50% of the retained level – when the reinsurer has to start paying out funds.

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This is one area that is not well-tended. One way to trigger a massive reinsurance audit is to have a file blow the $250,000 retention level without the reinsurer every knowing about the file. This happens more than one might think even in the age of advanced IT.

The level of insured authority will vary from state to state depending on how expensive files are in the states of coverage. Emails are great for documentation. Having the adjuster call for settlement or reserve authority is basically wasting their time.

Online access to all claims, or at least receiving a monthly loss report will avoid any surprises down the road. Online access is very well worth the extra charge if the TPA or carrier does not provide the service for free.

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Could Obamacare Cause Workers Comp Medical Treatment Rationing?

August 20, 2013 By JL Risk Management Consultants

Medical Treatment Rationing Possibility

Would Obamacare cause Workers Comp medical treatment rationing? Over the past few years, I had commented very often on the interfacing of Obamacare with Workers Compensation.

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The number one effect that seems to go unmentioned is the fact that medical care may (keyword may) be rationed overall.

My opinion is not based on any political agenda. It is based on the economic models of Adam Smith developed in the 1700’s – basic supply and demand. One of the hallmarks of the recent economic models (all based on Smith’s) is that if demand is increased for a good or service while the supply stays constant, the price will increase. However, if there is any type of governmental interference, then the whole market goes completely out of whack.

Governmental quotas, price supports, etc. have always thrown the market out of kilter. Would Obamacare be seen as the same type of governmental interference in the market? Supposedly, the numbers of “covered Americans” would approach 100%.

The basic Smith economic models says that when there is an increase in demand – more people seeking healthcare – while there are no more physicians or other healthcare providers being added, then where does that leave the injured Workers Comp patient?

Nurse Preparing Medical Treatment Rationing Syringe Injection

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What happens if instead of seeing the physician monthly all of a sudden all Workers Comp patients could only been seen bi-monthly? If a carrier/employer/self insured is paying temporary total benefits, this could be a very vexing problem.

If I was an adjuster, that would drive me totally bonkers. The part of my caseload that was drawing benefits would now be competing with the 100% -covered Americans. Would a boutique network established with for instance, an orthopedist, let my injured workers be seen more often?
The boutique WC network would be a carve-out of a network while an insurance carrier or TPA would pay MORE to have their injured workers seen on a timelier basis.

Of course, none of this may come to fruition. Many articles have been published where Obamacare may not actually cover 100% of Americans. Regardless, there will still be a larger number of people competing for those medical care slots.

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NCCI Report On Auto Accidents Has Interesting Subrogation Numbers

December 19, 2012 By JL Risk Management Consultants

Auto Accidents Report Has Interesting Side Statistics

The NCCI report on Auto accidents. NCCI (National Council on Compensation Insurance) is the largest rating bureau in the nation. Their statistics cover 21 or more states. One of most dangerous places to work is in your automobile according to their report.

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Surprisingly, the number of auto accidents that result in injury has been reduced by 37% since 1966 while the number of miles driven has tripled. This was likely due to safety enhancements over the past 35 years.

One interesting area of the report is subrogation. Subrogation is basically pursuing a third party that may be responsible for all or part of an accident.

According to NCCI, at 60 months after date of injury, about 1% of all claims involve subrogation. For motor vehicle claims, the percentage involving subrogation is almost 25%. The 25% figure is not an unexpected amount. Unless the accident involved a single car, there would be an element of subrogation to the accident.

The astounding figure is the average amount of subrogation is over 20% lower for motor vehicle claims than for all claims at 60 months ($8,570 for motor vehicle claims vs. $10,871 for all claims). There was no direct explanation as to why auto accidents are not more expensive.

One reason is that if a claim is subrogated for other than an auto accident, the injuries sustained must have been more severe. Another reason could be auto insurers are much more aggressive and knowledgeable on pursuing third parties than Workers Comp insurers.

If the auto adjuster pursues another party for an injury, Workers Comp insurers can subrogate their claim and “go along for the ride.”

This indirectly proves Workers Comp claims adjusters are rarely, if ever, trained in spotting third parties that may be responsible for an injury. For instance, if a machine in a lumber yard malfunctions and causes an injury, subrogation opportunities are being passed over quite often.

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The basis of the subrogation claim should always be the recorded statement taken by the Workers Comp adjuster. The adjusters gloss over the malfunctioning machine in the example. This can leave big Workers Comp $$ behind.

Many years ago, I was trained on subrogation very heavily. However, I was an all-lines adjuster. I was not specifically a Workers comp adjuster.

Should more than 1% of all non-auto claims be subrogated against another party? I would have to say definitely yes.

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First Reports Of Injury – File Them Online Now Or Pay 400% Later

October 31, 2012 By JL Risk Management Consultants

First Reports Of Injury Should Be Filed ASAP – No Excuses

Workers Compensation First Reports of Injury (FROI) are an employer’s first step in Loss Control. Loss Control is not the same as Loss Prevention. Loss Control to me is defined as the prevention of future losses AFTER an occurrence of a claim.

In fact, immediate filing of the first report of injury is one of my Five Keys To Cutting Workers Comp Costs. In a study of two different large collections of claims, I found that not filing a FROI quickly will increase claim costs by 400% on the average. *** Thanks to Frank Pennachio of The WorkComp Advisory Group for pointing out the mistake I made on the original post of this article.

Involving your claims adjuster very early in the process will always cut workers comp costs. In fact, the adjuster can rarely proceed without the filing of the FROI. One can look at the FROI as giving the adjuster permission to proceed on the claim.

One of the most important aspects of an employer that files FROI’s quickly is the impression that the employer is on top of their claims. Remember that this is the same person that will be setting reserves on this file and on files in the future. The FROI is the first impression that the adjuster has on the claim for your company.

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Laggard companies (insurance company lingo) will always have higher reserves on their files, plain and simple. If your company does not care enough to file an injury report timely, it is seen as a negative connotation on the file.

Electronic/online FROI filing has been around for quite some time. This is an example of an insurance carrier’s online filing page. In fact, some companies charge extra to input a claim off paper. Filing a paper FROI when online filing is available is seen by the clams staff as a negative connotation similar to late reporting of injuries.

Your company is almost guaranteed higher reserves than normal when the first time your claims staff or adjuster hears about the claim from a medical provider. What can the Workers Comp claims staff do when the medical provider is the first one to report the claim? They are going to refer them back to the employer as the FROI has not been filed.

Picture Xraymachine First Reports Injury

Wikipedia – Thomas Bjørkan

Once again, this is the same person that will be setting the reserves on the file that figure directly and are the most important variables in your E-Mod (X-Mod) or Loss Development Factor if you are self-insured. First impressions do count.

Insurance companies and TPA’s all keep very close track of the time it takes to file the FROI. The term is called “lag time.” It is measured from the time the claim occurs until an employer files the claim. If you mail it in, the days it takes for the FROI to be processed by the employer, mailing time, and for the carrier to process the mail all are figured into your lag time.

The easiest way to avoid all this is to file your claims online. If for some reason, your carrier or TPA does not have an online claim filing system, you should fax them. If a carrier or TPA does not allow for online claims filing, their claims processes should be viewed as antiquated at best.

Companies often contact us concerning their high E-Mods and ask us to help reduce them quickly. This is one of the areas we examine upfront in our E-Mod reduction programs.

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Workers Compensation Claims Adjuster Job Duties

September 19, 2011 By JL Risk Management Consultants

Workers Compensation Claims Adjuster Has 13+ Job Duties

The Workers Compensation Claims Adjuster – this is an excerpt from a manual I wrote 10 years ago. The only area I would add is the MSA component.

One of the most thankless jobs in insurance is the claims adjuster position. This manual may point out flaws in how file reserves and closings are handled by an adjuster. It is not the adjuster, but the WC insurance system as a whole that causes overcharges in employers’ premiums. The claims adjuster is the “mediator” between the claimants and the respective insurance companies.

Picture Of Doctor In Front Workers Compensation Claims Adjuster And Medical Personnel At Back

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The claimants want to be reimbursed or provided with whatever they ask, and the insurance company wants the claim to be settled for the least amount of funds possible, without the costs of litigation. Most claims adjusters are overloaded with claims. A claims adjuster must be the master of time management or they will quickly drown in their claims load.

Anything that will help a claims adjuster do their job can only help keep your reserves as low as possible. The Four Secrets of Saving WC $ on page 19 will help reduce the amount of time spent by the adjuster on your WC files. An adjuster only has so much time to devote to each file, so any extra time that you can give the claims adjuster will enable the adjuster to spend time on your files trying to reduce your costs, not just working on the files.

There are numerous tasks in a Workers’ Compensation claims adjuster’s job:

1. Investigate claims within 24 – 48 hours after receipt of the First Report of Injury.

2. Provide benefits to injured employees.

3. File proper forms with State WC Board.

Women Workers Compensation Claims Adjuster under maintenance

Wikimedia Commons – Suzanne M. Day

4. Set initial reserves on new claims and review reserves on established claims (usually for increases).

5. Pay bills on claims (medical, rehabilitation, defense attorney).

6. Settling claims.

7. General clerical functions.

8. Completion of periodic claims status reporting to insureds, carriers and/or reinsurers

9. Maintaining up-to-date file documentation of any development on the claim including phone calls, correspondence received and sent, review of medical notes, etc.

10. Minimum of monthly reviews of the claims (via diaries) to assure claim is proceeding accordingly toward closure. Maintain and update periodic action plans to move the claims toward closure.

11. Authorize and schedule medical appointments for the injured employees and follow up for receipt of medical documentation including work status reports.

Picture Business people Workers Compensation Claims Adjuster Group

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12. Follow up with employers to determine if work is available for the injured employee (limited duty or full duty) and/or assign vocational rehabilitation to assist the claimant in finding alternative work to lessen exposure.

13. Review files for reserve reductions or closings.

Please note that reviewing reserves for reductions and file closings are the lowest rated priority on the task list for claims adjusters. Why are they the lowest priority in the adjuster’s daily tasks? It is the nature of the insurance system.

Your efforts should be focused on the parts of your WC claims that will reduce the amount of time the adjuster spends on tasks #1 – #12 and increase the amount of time the adjuster spends on #13.

That is why it is so important that you review your monthly or quarterly loss runs upon receipt. If you see files that should be closed or reserves that are too excessive, email your workers compensation claims adjuster.

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Who Is A Public Adjuster for Workers Compensation?

May 16, 2011 By JL Risk Management Consultants

Term Of The Day – Public Adjuster

A Public Adjuster represents the insureds rather than the carrier during claims processing. In this way, insureds can be assured of their rights to insurance proceeds. These adjusters are normally paid on a percentage of the adjusted loss, or hourly, or on a per case basis.

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The workers comp public adjuster term denotes the cutting edge of this line of insurance. If one looks for this type of adjuster under a WC heading, they will find nothing.

I think of a public -type adjuster for workers comp as performing these tasks:

Reviewing all or a sample set of claims to insure the performance of a certain carrier’s claims staff
Making sure the reserves are set properly. See reserve explanation here.
Checking with the client to make sure they are satisfied with current carrier and address any problems
Request updates from adjusters (email only) on the larger files and all files within a year of opening
Monitor all large claims to enhance loss control over a certain set of claims
Reporting findings to designated employer on a monthly basis

Public adjuster guides appear all over the internet for Property and Casualty claims – think large property losses. In the future, workers comp claims staffs will hear from some type of public adjuster on open claims.

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When Is A Claim Compensable – Each State Has Its Own Inputs

April 20, 2011 By JL Risk Management Consultants

Compensable Claims Are State Specific

An injury that meets the statutory qualification standard in a Workers Comp policy. It is the term used when an injured employee is qualified to receive workers compensation benefits. The term compensable also applies to work related illnesses.

Picture Of Supreme Court Compensable In USA

Wikimedia – Jeff Kubina

Each state generates its own level of compensability. What may be compensable in Texas may not be in Ohio. Workers Compensation rules and laws have a commonality among all states. However, deeming a claim as payable or not is very state-specific.

This may turn on a dime when a State Court of Appeals or Supreme Court hands down a major decision. Workers comp adjusters make the compensability decision within a certain state-prescribed timespan after a thorough and complete investigation.

Once the decision is made on whether a claim is compensable or not, each state has very specific forms to inform all parties involved on the compensability decision. Many insureds require a review of each large claim as to its compensability. The requirement exists especially with a self insured that has a TPA adjusting its claims.

The dictionaries generically define it as entitling one to compensation. The origin of the word comes from the French.

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How Do I Find Outside Adjuster Job

January 10, 2011 By JL Risk Management Consultants

Term Of The Day – Outside Adjuster

An adjuster who usually spends 3.5 days or more on the road handling claims. Workers Comp claims department evolved in the 1980’s to all but eliminate this type of adjusting. Most companies now use telephone adjusters to handle Workers Comp claims. I think the cost benefit analysis would show that there is a cost justification for outside/on-the-road adjusting. I used to be an outside Workers Comp claims adjuster when I first started in insurance.

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Workers Comp Claims Adjuster – Defending Tough Job

June 8, 2010 By JL Risk Management Consultants

Workers Comp Claims Adjuster Can Be A Tough Job

The Workers Comp Claims Adjuster possesses a job that can be nerve wracking. One of our services is to review files to see how the claims adjusting staff performed on a group of claims. I had recently read a LinkedIn post slamming Workers Comp claims adjusters. The poster had recommended to the other readers to challenge an adjuster by asking them to on-the-spot give an immediate answer on a claim. I see this in posts and artifices approximately twice per year.

Graphic Of Gavel Workers Comp Claims Adjuster Defense

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Asking an adjuster to discuss one file on-the-spot is the same as asking someone what they had for lunch over a month ago. We recommend that an employer establish a working relationship with their adjusters. Expecting an adjuster to not pull the file and review it before giving an answer or status is going to leave an employer disappointed.

We always recommend emailing adjusters and expecting an answer to the email within 24 business hours. This allows the Workers Compensation adjuster time to review the part of the file to give an acceptable answer. An email is very strong written documentation for the employer and the adjuster.

I wrote about this situation in a manual that I wrote on controlling Workers Comp costs.

Who Is Your Medical Only Claim Adjuster – Name Please

May 20, 2010 By JL Risk Management Consultants

Your Medical Only Claim Adjuster Important Team Member

The Medical Only claim adjuster is the person that are usually handling the more serious medical only claims.A large number of our clients have received our heavy recommendation to get to know their lost time claim adjuster(s). The adjuster(s) have a huge effect on your company’s Workers Compensation premium. We are often brought in as consultants to discuss files with the claims adjusters.

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One group of personnel that almost no employer or risk manager establishes a working relationship with is the Medical Only adjuster. Why is this so important? I have coined the term – festering claims. The Medical Only adjuster is the person that are usually handling the more serious medical only claims. The Medical Only adjuster also handles the claims by paying the medical bills on a very large group of claims. I have rarely seen a carrier where the lost time adjuster handles medical only claims.

I have seen so many serious claims not being handled properly as there seems to be a communication breakdown when the lost time adjuster is not handling the file. The employer will inform the lost time adjuster of a development on a medical only file. The lost time adjuster then has to hand off the info to the medical only adjuster. Often the necessary attention for a “festering file” is not given.

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The file will then not have the proper investigation initiated until the loss control on the file is beyond repair. This type of file is much worse than a file that has had the attention of the lost time adjuster since day one.

I am not blaming anyone. This is just the nature of the beast in the Workers Comp claims industry. The claims industry is a sink or swim business.

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Who is your medical only claims adjuster?The largest concern that we have with Medical Only files is not the normal files. In our reviews, we almost always see a few or many festering medical only claims. The file has made a turn for the worse and the proper investigation is delayed as the medical only adjuster’s job is to facilitate the timely payment of medical bills, not adjust the file. They are usually overloaded with hundreds upon hundreds of files.

The other situation we see with festering medical only claims is when the employer has not informed the medical only adjuster that the file is now becoming a more serious matter.

The backstop for both of these situations is when the file reaches a large amount of medical payments and the file pops up on the carrier’s or TPA’s radar. These can turn out to be very expensive files in the long run.

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As I have posted very often, an employer that has online access to their Workers Comp claims will usually have a great advantage. While it is the job of the adjusting staff to watch over claims that are becoming more serious, the employer can call attention to the claims that are reaching large $ amounts but are not classified as lost time files. One of the huge red flags is a very large medical bill or bills with numerous dates of treatment.

As the title indicates, knowing your medical only adjuster or adjusters makes the process of alerting the carrier of TPA to a more serious medical only. An email to the medical only adjuster with a cc: to the lost time adjuster works very well. It is not a good idea to assume the claims adjusting process will take care of itself.

All of our clients do know who their Workers Comp lost time adjusters and medical only adjusters are on their company’s files and have realized premium savings on this simple tip.

Workers Comp Claims Processing Manual Needs ASAP Theme

March 3, 2010 By JL Risk Management Consultants

ASAP-Workers Comp Claims Processing Manual

The Workers Comp claims processing manual – ASAP must be built into it from the first sentence .

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We often have to examine a carrier or TPA’s claims adjusting manuals while performing our file performance audits for employers. One area that can help to control claims costs is the initial three point contact (Employer, Employee, and Physician).

All the claims manuals properly address the information needed from the three point contact. We sometimes see the manuals requiring that the three point contact be completed within 48 or 72 business hours. This to me is a large mistake as the claim is set in stone approximately two days after the accident.

The carrier that trained me quite a few years in the past would not accept the three point contact not being completed with 24 hours after receiving the first report of injury even on weekends. A claim does not stop because of Saturday or Sunday.

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In my opinion, most of the CRITICAL work by the claims adjuster needs to be completed within 24 hours after receiving the first report of injury. The medical treatment can be controlled and the employee can be directed by the employer’s choice of physician if the claim is attended to ASAP. Contacting the employee within 24 hours lets the employee know their claim is being attended to in an expedient manner.

The employer’s responsibility in the process is to report claims as soon as possible and to direct the employee to the proper medical care. The time clock is ticking once the employee reports an on-the-job injury.

A Workers Comp claims processing manual is constructed as an afterthought most of the time. The claims department writes the manual and it then collects dust on the shelf or is an oft-ignored online module.

Pinnacol Opposes New Colorado Bills

November 16, 2009 By JL Risk Management Consultants

Pinnacol Opposes New Colorado Bills In State Legislature

Colorado’s Pinnacol opposes quite a few Workers Comp Bills this week. I have seen articles over the last week that Pinnacol has opposed a number of bills that are now in the Colorado legislature. Most of opposition from Pinnacol is justified in my opinion. However, there is one area that I do not agree with overall. I have seen this often in Workers Compensation claims adjusting units. I also see it in our file reviews for self-insureds and larger employers.

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Providing adjusters with incentives on the number of denied claims is somehow fertile ground for conflicts of interest. An incentive for very low settlements is also one that I have seen over the years. I do not agree whatsoever that adjusters’ denial performance should be rewarded. In one carrier where I used to be employed, there were actually trophies and plaques given out for denial rates and low settlements.

Adjusters are supposed to give unbiased opinions and decisions on Workers Compensation files. In our file reviews, we notice that most denials are either won by the injured employees or settled.

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I think the reserving efforts by adjusters should be monitored more than anything else they do in their job. Please feel free to use the search box on the right side of the screen using reserves as a search term to see my opinion on inaccurate reserving. I have posted many articles on the over-reserving of files and the harmful effect to employers. Under-reserving can also be harmful if not monitored properly.

Do adjusters need to perfectly estimate the reserves on the file at the outset of the claim? No – but they do need to monitor the reserves closely for changes in the file that would affect the reserves.

Workers Comp Adjuster How To Contact on Reserves and Payments

August 27, 2009 By JL Risk Management Consultants

Contacting Your Workers Comp Adjuster – A Few Quick Tips

Your Workers Comp adjuster appreciates emails. Let us cover why adjusters prefer emails to phone calls, faxes, or letters.

This is one area that we have received quite a few calls over the last few weeks. If you as an employer feel that you are not sure how to proceed, you are in the majority.

As I have posted in the past, these conversations with your adjuster over Workers Comp payments can save money or cost your company greatly. Knowing which files to cover is crucial. Sometimes asking the wrong questions on the wrong files may cause a reserve increase. If you ever feel that you may cause more harm than good, it may be a good time to call in a reserve expert.

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I always recommend never emailing your adjuster and to say that the reserves on the files are too high and you want them reduced. I have seen agents do this. All this will ever do is cause a breakdown in communications.

Please remember that an adjuster can increase or decrease reserves at will – and there are no laws on the books that address how an adjuster handles reserves. Making any communications to adjusters a contentious situation will only make things worse and never accomplish your goals. Almost all Workers Comp adjusters are very overloaded, especially in this economy.

One thing that adjusters like is that you do not contact them if the question is on a payment. Emailing the adjuster’s assistant will usually accomplish what you need to know. Ask your adjuster to provide their assistant’s email address. This is the best person to email on payment questions as the adjuster will only forward your email to their assistant to answer the payment question.

Workers Comp Adjuster – Suggestions For Working Relationship

August 25, 2009 By JL Risk Management Consultants

Workers Comp Adjuster Communication Always Saves Premiums and Budgets

Communication with your Workers Comp Adjuster. I have posted on this subject a few times in this blog. As I mentioned in the last post, your Workers Compensation adjuster is very important to your overall insurance budget. The following are a few tips on how to establish a working relationship with your adjuster:

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Knowing who handles your company’s claims – we often come across companies that do not know who is handling their files. I suggest immediately finding out the contact information of the adjuster or adjuster who is responsible for your company’s claims.
Phone calls and faxes are not going to get answered as promptly as emails. If you call your adjuster, they will only have to pull the file and get back to you. Phone calls are not recommended.
Emails are great documentation and allow your adjuster to give you an answer after reviewing the file. They are probably overloaded with files and need the time to familiarize themselves with the file. Scanning and attaching documents to your emails may also be a great idea.
Some insurance carriers and TPA’s have a concise claims status on the loss runs. The current status field – usually two or three sentences – may avoid the need to contact the adjuster directly. If the status seems to be out-of-date, email the adjuster to provide them with an new information.
Online claims access is the key to cutting down on the need for multiple communications on the file. As I have posted numerous times, online claims access is golden for knowing the status of the claims. Having online access will avoid you having to make status emails and phone calls to the adjuster.

I will post next time on contacting your adjuster(s) on reserves and payments.

Workers Comp Reserves – Large Reader Response

August 21, 2009 By JL Risk Management Consultants

Workers Comp Reserves – The Skinny

An article this week on Workers Comp reserves generated a huge response. I was going to post on Class Codes 8810 and 8742. This blog had the largest one day total of visitors ever earlier this week.

I will cover more material on reserving in this post. Thanks to all of our n

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ew visitors, daily readers, and newsletter readers. If you are reading this and want to receive our weekly newsletter of the blog posts, the sign up button is down the page on the right side.

Reserving is actually an art of sorts. As I had told three different reporters this week, we all heal much differently. Our healing and return to work abilities vary as much as DNA varies which is greatly.

I received a large number of inquiries from employers on how to reduce or control the reserves on a single file or group of files. This is very difficult without at least 5 years of Workers Comp adjusting experience. Each state has their own guidelines on Workers Compensation, so how does an adjuster keep up with multiple states? It is very difficult at best.

I am going to let you in on a little secret. There is a person that has the COMPLETE control over your Workers Comp budget. Is it the actuary, agent, underwriter, or loss prevention rep? It is your workers comp adjuster. If you do not have a working relationship with your Workers Comp adjuster, you are burning through cash quickly. Why?

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The only unregulated part of the Workers Comp insurance premium process is the reserves that an adjuster sets on the files? I have dealt with laws and regulations in over 30 different states. I have yet to see rules on how an adjuster sets reserves on a file. There are volumes on how the claims adjusting staff is to handle claims, but nothing on the books for reserves. I have seen many lawsuits on how claims have been handled but only a very few on how the claims were reserved.

How do you establish a working relationship with your Workers Comp adjuster? This post is getting long. I will leave that for the next one. Class Codes 8810 and 8742 will have to wait.

Workers Compensation Claims Adjuster – Friend or Foe?

March 10, 2009 By JL Risk Management Consultants

The Job Of A Workers Compensation Claims Adjuster

A Workers Compensation claims adjuster – are they friend or foe? Many years ago, I started out my career as an insurance adjuster trainee.

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The adjuster has more to do with your Workers Comp premiums than any underwriter, agent, or premium auditor. I thought I would go over a few interesting and probably unknown aspects of a very tough job in the insurance industry.

One of the most thankless jobs in Workers Compensation or any other type of insurance is the claims adjuster position. In this blog, I may point out flaws in how file reserves and closings are handled by an adjuster. It is not the adjuster, but the Workers Comp insurance system as a whole that causes overcharges in employers’ premiums. The claims adjuster is the “mediator” between the claimants and the respective insurance companies. The claimants want to be reimbursed or provided with whatever they ask, and the insurance company wants the claim to be settled for the least amount of funds possible, without the costs of litigation.

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Most claims adjusters are overloaded with claims. A claims adjuster must be the master of time management or they will quickly drown in their claims load. A usual claims load is from 125 – 300 files. If the claims adjuster has over 200 files, you as the customer, are not having your files handled properly. There are a very few adjusters who can handle more than 200 files. If your files are split amongst numerous adjusters, each of them still needs to be handling 200 files maximum.

Anything that will help a claims adjuster do their job can only help keep your reserves as low as possible. The Four Secrets of Saving Workers Compensation premium that I posted previously will help reduce the amount of time spent by the adjuster on your WC files. An adjuster only has so much time to devote to each file, so any extra time that you can give the claims adjuster will enable the adjuster to spend time on your files trying to reduce your costs, not just working on the files.

Most Expensive Component of All Workers Comp Claims

March 8, 2008 By JL Risk Management Consultants

Most Expensive Component on Claims

The most expensive Workers Comp claim component seems to be premium-based. This is one that surprises most people.

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When I ask this question at presentations, the answer is usually the medical cost of the claim, or pharmaceuticals, or even settlements.

The most expensive part of a Workers Compensation claim is….poor adjusting decisions. If the Work Comp claim adjuster makes a mistake on the file, the insured/employer ends up paying for the result of that mistake through a higher E-Mod, resulting in higher premiums.

One of the most common mistakes we see is in the area of file reserving. Check back on the blogs where I mention Worst Case Scenario. Your Workers Comp premiums are calculated from the reserves on a file, better known as the total incurred. AS I HAVE SAID NUMEROUS TIMES IN THIS BLOG, WHAT YOU HAVE PAID ON A CLAIM HAS LITTLE OR NOTHING to do with the Workers Comp premium paid. It is the total incurred that matters. Please see my prior posts on total incurred.

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In my years in insurance companies and TPA’s, the only employees that understood what goes into paying premiums at the most basic level was the Workers Comp claim department. However, no adjuster has an exact idea of what effect a file reserve or total incurred has on an employer.

The other area that we see most of the errors and higher cost is in how expedient the employer was in reporting an accident (lag time) and how quickly the adjuster made the appropriate contacts. Within 48 hours AFTER AN ACCIDENT HAPPENS, the Workers Comp claim has already established its final cost factors. Yes, in 48 hours the claim’s direction cannot be changed. There is a prior post of mine on that subject.

Next Up – My Company is in the Assigned Risk Pool, are we paying that much extra, and if we are, how do we get out of it ASAP?

Claim Auditing and Adjusting Tips – Claims Q&A With Claims Coach

January 29, 2008 By JL Risk Management Consultants

Claims Q&A With Kevin Quinley – Claim Auditing Discoveries

We were caught up in a huge Workers Comp consulting project and I have neglected the blog page. OK, so here is the next installment of Claims Q&A with Kevin Quinley on claim auditing discoveries.

Claim Auditing Questions . . .

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In doing claim audits, are there recurring issues or problems you see with claim-handling?

There are two that we see the most which heavily affect the outcome of a WC file. Those two are Immediate First Contact and Poor Communications. Often we see where an adjuster writes the injured employee, employer, and treating physician a form letter and then documents that there was immediate three point contact. Talking with the employer, doctor, and employee about their WC claim ASAP is a great way to start the proper communications in the file.

The other related area is adjusters working the file, but not making any contacts with all or at least some of the parties involved. Good communication is the main job of the adjuster. If this is not done as shown by a trend by an adjuster or by a TPA/Carrier, we become very concerned.

What are the most common findings or observations during claim auditing? See previous question.

How should claims people prepare for an audit before undergoing one?

Quit stressing when they hear their files are being audited. Some file audit firms consider a very nervous adjuster as a “red flag.” There is nothing that can be done to do a “quick-fix” on the files. The one thing that I recommend is to be friendly and smile at the initial meeting. Do not EVER put the auditor on the defensive if they ask you a question. Auditors that are on the defensive tend to be more subjective in their file appraisals.

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Are there “red flags” you look for when doing a claim audit?

We do heavy statistical analysis on the 33 areas that we look at for trends. If there is a trend by adjuster or insurance carrier, then we red flag that one area. This happens very rarely except in one area. Over-reserving or under-reserving the files is a red flag that we notice very quickly. We do stat analysis to confirm our findings. The numbers speak the loudest.

Over the years, do you sense any differences in skill among the claims profession in general? Is claim service getting better or worse?

Claims adjusting has followed a definite trend. It is how the industry or a certain carrier decides on the file loads for adjusters. An overloaded adjuster cannot do the job that the insureds are relying on them to do on their files. When the industry/carrier trend is to lighten loads, the file handling improves proportionally.

For a firm looking to tame its workers compensation claim costs, what is the ONE thing they can do to deliver the greatest return on investment?

Time Management training pays big dividends. Stress management seminars seem to help. The old “claims roundtable” is also a great meeting to have for adjusters to discuss difficult files. We can tell the difference on file reviews between trained and untrained adjusting staffs. The one word is training.

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How do workers compensation claims people avoid getting burned out?

As mentioned before, they must remember that they ARE NOT claims adjusters. That is their job. In other words, leave it all at work. That is the secret to surviving in claims. Forget the files when you walk out the door every evening.

In a blind taste test, can you tell much of a quality difference between TPA claim services and insurer/staff claim services? Comment, please.

Yes, when we compare files where a carrier also functions as a TPA. Flat-fee files seem to receive less attention.

If there is indeed a “brain drain” of seasoned claims people retiring, how can companies counteract that trend to salvage acceptable levels of expertise?

There are carriers that do a great job of training incoming recruits. They also weed-out recruits that will not make it in the adjusting world. Liberty Mutual has an outstanding training program. Training and screening will fight the brain drain.

What are employers’ biggest complaints about workers compensation claim service?

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As I mentioned before, it is poor communication. They often do not know what is happening on their files. I always tell employers to request online claim access as they can follow the files without having to disturb the very busy adjusters.

What is the ideal caseload for an adjuster handling lost-time workers compensation files? Comment.

Oh, this is a loaded question. It depends on the state, but I would say 100 for a claims trainee, 150 – 175 for an experienced adjuster, and 200-225 for a Senior Adjuster. In my career, I have had to handle 250 files in 7 jurisdictions/states at one time. I juggled it very well until I burned out from fighting fires.

Next Up – Workers Compensation News

Work Comp Claims Productivity Q&A Kevin Quinley

January 15, 2008 By JL Risk Management Consultants

Work Comp Claims Productivity Q&A With Kevin Quinley

Work comp claims productivity advice comes from so very few sources nowadays. OK, so I have been out of action on the blog for the holidays. Business has picked up tremendously, so the Workers Compensation blog has been suffering. I will not go over the best designation for claims or reserve reviewers today.

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I will instead add in the Work Comp Claims Productivity Q&A session with Kevin Quinley of Claims Caffeine. Kevin asked very good questions. The address to join Claims Caffeine is https://login.yahoo.com/config/login_verify2?.intl=us&.src=ygrp&.done=http%3a//finance.groups.yahoo.com%2Fgroup%2Fclaims_caffeine%2Fjoin

You must get a lot of email. How do you manage it and stay on top of it?

I do not try to answer every email as I receive it. I set aside three times in the day where I answer emails. If you are accustomed to Outlook, you can direct certain messages into certain Outlook email folders. For instance, if it comes from a high priority sender, the email message will go into the High Priority box.

I also use Maven Beacon teaches typing to hone my typing skills. There are many levels of instruction on a typing teacher program such as this.

LG Work Comp Claims Productivity Mobile Phone

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Do you use a Blackberry or PDA as a productivity tool?

No, but I use a LG AX490 cell phone to surf the web and to answer and send emails. That phone is the only one like it in existence. It has a full keyboard built in right on top of the number pad.

What are your biggest interruptions and how do you manage them?

My biggest interruptions are phone calls that could have been handled by an email. We try to contact adjusters by email only as that saves the adjusters’ time and the notes are easily added to their file documentation.

You must travel a good bit. What tips do you have for readers on how to save time and stress during business travel?

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Airports are slammed with passengers and will be for many months to come. You are likely not going to get to your destination on time. Accept that fact and the stress will lower quickly. A real time saver is to print the boarding passes out the day before you fly. Always join any and all frequent traveler programs. Even if you do not use the airline, hotel, car rental etc that often, you will be treated better than without a frequent traveler #.

If you drive a large amount of the time, try to listen to Books on CD/Tape as a great diversion. My favorite is the 7 Habits of Highly Effective people. There is some incredible advice on settling files in that Book on CD. The chapter on win-win is a great one for claims people.

If you could offer just one productivity tip, what would it be?

DO NOT stress out. Study after study has shown that one loses about 40% of their productiveness under stress. You are the expert, so be the expert.

Do you use a daily To-Do list? If so, how long is it usually?

Yes, I use a To-Do list on Outlook. I actually switched from the Outlook task list to using just the Calendar as the tasks just have to be calendared and that takes two steps to do the same thing. My To-Do list has a rolling average of twenty items.

How do you set your day-to-day priorities amidst shifting work demands?

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Many years ago I was sent for two days of training conference on setting priorities. The bottom line result:-
· AA –Do it immediately
· A – Do it that day
· B – Do it that week
· C – Do it that month.

Each priority will move up the line during the daily routine. Some priorities could move down the line. Keep working on the top 20% (AA and A). If you can get through the A’s and start working on the B’s, there will less fires to put out in your daily routine.

How do you find time to keep current on professional reading and developments within your field?

I subscribe to about twenty different e-zines (all free of charge). I read the headlines and then print or copy and paste the document to my desktop in a folder called reading material to read at the end of the day. If I cannot find time to read them at least I read the headlines.

What is the one thing you wish you had known starting out in your business that you know now?

QUIT STRESSING. Claims is a &$^#* job if you let it stress you out. Keep calm and remember that claims adjusting is a job. Never refer to yourself as a claims adjuster. Leave the job at work.

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Based on how you see claims people work, how do you think they could work smarter?

Keep the stress level low. Do not take the job home with them. I see too many adjusters just freak out on an audit of their claims. Guess what? Most of the time they are doing a good job. You are the experts, so act like and be the experts.

Return all calls, emails, and all other communications within 24 business hours. You do not have to have an answer. Call/email and say I just wanted to let you know I am working on it and I will get back to you by a certain date or when a certain thing happens. As the old saying goes – when you are silent, people will expect the worst.

Bottom Line – quit stressing, be confident, do your 24 hour contacts, and communicate. Your Work Comp claims productivity equates to your own self confidence.

Next Up – Workers Comp Claims Auditing Q&A from Kevin

Work Comp Adjuster Top 10 Contact Recommendations

November 29, 2007 By JL Risk Management Consultants

Work Comp Adjuster Contact Can Affect Reserves Heavily

Did you contact your Work Comp Adjuster this week or month? Why did you not?

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If you have found something questionable about your total incurred or reserves, then you may want to contact your Work Comp adjuster. Politeness and establishing a working relationship goes very far with knowing your claim statuses.

From being an adjuster many years ago and listening to adjusters’ comments, there are a few simple rules that will help you in discussing reserves/total incurred when contacting your adjuster:

Know who your Workers Comp adjuster is for every one of your claims, even if you have a new carrier. If you do not know who this is – you need to find out.
Email your adjuster – calling your adjuster is OK, but they will still have to look at what you are questioning and get back with you. Do not expect immediate answers.
Do not say, “My reserves are too high” without specifics. We see agents do this one very often. Make sure you are updated with all the info.
Be very specific with your questions. Do not send the adjuster a three page email.
Quite often, the adjuster does not know of a claim’s development that would make the file worth less $. Updating the adjuster by email on what is happening on the claim is a great idea. It is even better to scan and email or fax any info that you receive on the claim to the adjuster ASAP.
Never threaten the adjuster with the Insurance Commissioner. This is only as a last resort. Please remember you may have to work with this person on your claims for many years.
Do not immediately ask for the adjuster’s supervisor. Give them time to resolve your concerns.
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KNOW WHEN YOUR TOTAL INCURRED AND RESERVES hit your E-Mod. Calling an adjuster two weeks before your policy expiration is fruitless. See my old posts or email me at [email protected] on when your E-Mod is affected.
Self-insureds – the adjuster is spending your $ directly from your budget. Even though there are no E-Mods to be concerned with, your Workers Comp LDF’s are calculated from the reserves for budgeting purposes. We sometimes hear self-insureds say that they are glad they are not in the insurance system. Actually, you are even more than the non-self- insureds.
If you feel that you would be in over your head, contact a claims professional – shameless plug – that is what we do every day.

Workers Comp is full of buzzwords. Please click on https://cutcompcosts.com/ and click on the Definitions tab for a large list of definitions or email us at [email protected] if you have questions on any of the terms used in this or prior posts.

Next Up – The Easiest Way to Monitor Your Claims and Lower Your Premiums