claims department

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

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

Workers Comp Adjuster Goals Conflict With Management Expectations?

Advocacy Model vs. Workers Comp Adjuster Goals – A Point Missed?  Did I miss The Point  – Maybe?  I recently attended a webinar provided by the National Workers Comp and Disability Conference where some of the Workers Adjuster goals were compared to the expectations of claims management.   Two of my

Talented Workers Comp Adjuster – Do They Have IT?

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. I have attended many conferences

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

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. 

COVID Compensability Conundrum – Who’s Covering What?

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.    Most states have a disease statute.  Not many states include personal sensitivity

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

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.    I added in an article pleading with adjusters

A Work Comp Claims Department and Chernobyl – One Major Similarity

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

Work Comp Claims Adjuster Survey – Finally – Your Opinion Matters

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.  Any person that works in the worker’s comp claims arena knows that sometimes they are completely left

National Adjuster License For Workers Comp Quite Challenging

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.   The

Workers Comp Automation Can Replace Claims Adjusters

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

Work Comp Adjusters – Settlement And Reserve Authority From Insureds

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. The previous blog article that I had written

Workers Comp Adjusters – Feel Good Friday

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 –

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

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

Workers Compensation Predictive Modeling Will Never Work

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. There are many predictive models on WC.  Those models usually leave the observer with

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

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

Settlement Authority – Should Adjuster Ask Insured?

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.

Could Obamacare Cause Workers Comp Medical Treatment Rationing?

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

NCCI Report On Auto Accidents Has Interesting Subrogation Numbers

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.

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

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

Workers Compensation Claims Adjuster Job Duties

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

Who Is A Public Adjuster for Workers Compensation?

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

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

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. Each state generates its own level of

How Do I Find Outside Adjuster Job

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

Workers Comp Claims Adjuster – Defending Tough Job

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

Who Is Your Medical Only Claim Adjuster – Name Please

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

Workers Comp Claims Processing Manual Needs ASAP Theme

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

Pinnacol Opposes New Colorado Bills

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

Workers Comp Adjuster How To Contact on Reserves and Payments

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

Workers Comp Adjuster – Suggestions For Working Relationship

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

Workers Comp Reserves – Large Reader Response

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

Workers Compensation Claims Adjuster – Friend or Foe?

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. The adjuster has more to do with your Workers Comp premiums than any underwriter, agent, or premium auditor.

Most Expensive Component of All Workers Comp Claims

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

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

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 . . .

Work Comp Claims Productivity Q&A Kevin Quinley

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

Work Comp Adjuster Top 10 Contact Recommendations

Work Comp Adjuster Contact Can Affect Reserves Heavily Did you contact your Work Comp Adjuster this week or month?  Why did you not? 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



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