The toughest job in workers comp

is that of claims adjuster.
Whether you know them as adjusters, examiners, file handlers, or claims case owners, these women and men are the ones who write the checks out of the checkbook – both literally and figuratively. What they do, and how they do it, has more impact on the success or failure of an insurer or employer’s work comp program than any other position (although some underwriters would argue they’re just as important).
Adjusters determine compensability; keep an eye out for fraud; authorize indemnity payments; encourage/direct/cajole claimants to go to preferred providers; interface (or, as one seasoned adjuster referred to his approach, ‘in-your-face’) with claimant attorneys; meet with employers’ risk managers to review claims, discuss reserves, and encourage RTW planning; set, change, and justify reserves; encourage, and in many cases educate treating docs to think about RTW; try to figure out if this or that unpronounceable drug is appropriate for the claimant’s condition; authorize, or deny, medical treatment; prepare and present cases to hearing judges; explain to their managers why they can’t get a case closed or IME scheduled.
All this while looking every day at a case load that, a decade ago, would have seemed far too large. With claims case loads at many payers in the 150 range (lost time), adjusters have about twenty minutes a week to focus on each claim.
Twenty minutes.
Of course, this is before we factor in the other stuff; ongoing CEUs required in many jurisdictions and the training requirements for new products, vendors, programs, and technology innovations.
And recall that we’ve been hammered by a work comp market that’s been soft as fresh WonderBread for several years, leading payers of all types to consolidate, cut staff, hold off on investments in technology and workflow improvements, and require everyone to ‘do more with less’.
I’m often asked by those in- and outside the comp business what the secret to success is. In most cases, the answer is the same:
Take work off the adjuster’s desk and put it on your’s.
Mark Wall’s LinkedIN group always has great insights; for more detail on what these folks go thru, and how those struggles affect their ability to handle claims effectively, check out this conversation .