Medical claim adjusters should really receive an award. After all, they have to diplomatically pacify upset parties from every angle: the doctors, the claimants, and the employers. While juggling all of these negotiations, it’s not unusual for critical information to simply get lost in the shuffle – forms take a long time to get filled out, aren’t filed properly, or are blatantly mishandled. But there is a solution.
Here’s what employers can do to save time, money, and aggravation when dealing with the claims process.
Tip #1: Manage the Claims…Together
One of the biggest mistakes employers make when working with their claims handler is not being on top of claims themselves. They assume that if they filed a claim with their workers compensation insurance provider they can remain uninvolved for the duration of the claim.
But here’s what employers must realize: While you only have one adjuster assigned to each case, you are NOT their only client. In fact, this claims handler may be juggling hundreds, maybe more, of claims at any given time. And as in any industry, mistakes happen, details are overlooked, and human error is abundant. Deadlines are always around the corner, mediations are looming, and the demands are endlessly tightening around an adjuster’s neck, making it all the more beneficial for a savvy employer to work hand in hand with their brokers.
Remember, the longer your employee is out of work, the more money you lose. And neither the employee (who is probably enjoying their workers’ comp) nor the adjuster (who is drowning in a sea of claims) is going to keep on top of the status of your claims. So you’re just going to have to do it yourself.
Tip #2: Stay in Constant Communication
In general, in the claims industry, there is simply more work on the average adjuster’s plate than one person can handle. The claims process can take longer than necessary and settlement offers can go unresponded to for way too long. That can happen to you…unless you take the more proactive approach.
A good adjuster can save you money; they can minimize the workers’ comp claim costs, offer alternate solutions, and get your workers back on the job faster. If done properly, a good adjuster will facilitate a quick return to work for the employee, minimizing your costs. Of course, they’ll need thorough documentation for this to happen, starting from the time of the injury and continuing through the employee’s progress. This is why it’s so important to be in constant contact with your insurance company and/or claims adjuster.
Tip #3: Financial Benefits of Staying Involved
There are some money saving benefits to staying involved with your workers comp claims and policies. For example:
- Since adjusters are handling so many claims that involve so many phone calls, emails, and meetings, it’s easy to miss that two-line email from the doctor saying your employee should avoid heavy lifting for the next two weeks. Your worker may assume this means he gets to stay home, claiming he’s “off the hook” from work since his job entails heavy lifting. If the claims broker had noticed that email in time, however, she could have suggested alternate work options such as filing, data entry, or other non-labor intensive work that this employee could have been doing for you (instead of simply costing you money for no return). But your claims handler only opened the email two weeks later. When you are in constant contact, however, this kind of slip up doesn’t happen, and a more cost-efficient solution can be found easily.
- A second opinion can be called in the event that you are not satisfied with the initial medical reports or diagnosis. In many states, this request must be made within a specific timeframe, making it all the more important for employers to be on top of the claims status (before the deadline hits). Make sure to receive all medical updates and ask questions when something doesn’t seem right.
- An employer often has information about the injured employee that the insurance company does not have. Information such as pre-existing conditions or additional employment may factor in determining the cause of the injury and must be relayed to the adjuster working on the case. Any employer will gain from determining and communicating any influential evidence that may have led to the employee’s injury.
- Often an employer stays out of any legal settlements made between the employee and the insurance company. By paying attention to settlements and keeping communication open with the insurance company an employer may be able to influence lower settlements.
Bottom Line: What Should You Do?
An open line of communication with your Insurance company and claims adjusters will speed up the claims resolution, saving you time, money, and frustration. Communication is key. This involves follow-up phone calls at various stages in the claims process, asking important questions, and paying attention to why and how long claim remain open. This is the only effective way to efficiently resolve the claim properly. Additionally you can:
- Remain in constant contact with medical providers and employees themselves to facilitate a faster return to work
- Ask adjusters about return to work or modified work programs
- Send initial checklist along with the claim to help your insurance broker stay organized
- Include all information within your initial claims report (including factors that may affect the claim such as outstanding medical issues, third-party blame, or suspicion of fraud)
- Make sure the adjuster is in touch with the employee early on, avoiding unnecessary and complicated legal communications
- Pay attention to adjuster’s behavior and discuss any unethical or problematic practices you notice
- Discuss workers’ comp claims before the renewal date to minimize the costs
And don’t forget to tell your adjuster how much you appreciate all their efforts! A little gratitude can go a long way (and will really stand out) when they are dealing with hundreds of claims each week.
With over 10 years of experience in managing workers’ comp claims Tehila understands well the struggles involved. Joining Modwatch gave her the opportunity to use her passion of reducing work related injuries, getting employees back to work, and helping reduce insurance premiums to help others.