The Importance of a Claims Adjuster

The Importance of a Claims Adjuster

Claims adjusters play a vital role in the resolution of workers’ compensation claims. Doing the job well requires great time management skills and industry expertise, but all too often companies cite statistics that don’t truly reflect effectiveness. Here’s what a claims adjuster does, how a good claims adjuster can make a significant difference, and how you can differentiate between good, bad, and mediocre performance.

What Does A Claims Adjuster Do?

Basically, a claims adjuster investigates workers’ compensation claims to determine whether the claimant can legally receive compensation. They work with the injured worker, their employer, and the insurance company to protect everyone’s interests. If they find the claimant qualifies under the Act, they approve and monitor appropriate care and authorize benefits.

Claims adjusters handle many cases, answer many telephone calls and emails, and sift through volumes of paperwork. However, they must still do a thorough job as quickly as possible.

A Good Claims Adjuster

Workers usually deal directly with a claims adjuster and it is important the adjuster has expertise in the accident type and the severity of the injury. A good match speeds the claims process towards resolution. Experience can also mean recommendations to appropriate doctors and a suitable return-to-work program.

A good claims adjuster contacts the claimant and employer as soon as possible. This builds trust and puts both parties at ease, which makes the entire process easier. All adjusters ask basic medical questions, but good adjusters review the information carefully to determine whether it has a bearing on the case. For instance, if the person has an existing condition, it could affect treatment options and the urgency of care.

As the claim progresses, a good claims adjuster communicates in a timely manner. They provide a personal touch, even if they’re very busy. Constant contact helps the worker, employer, and doctors understand the status of the case and next steps. They also ensure prompt payment of medical bills and indemnity payments, and they submit the appropriate forms to state bodies.

Claims adjusters also identify fraud and pursue third-parties if they were the cause of the employee’s injury. They also attend mediations when the parties cannot come to a quick agreement and look for ways to settle claims whenever possible.

Evaluating Performance

Many companies “handle” claims, but that’s often nothing more than moving files from the “In” box to the “Out” box. It takes minimal company effort, but it often means the employer pays much more than they should.

Instead, your business should examine how long it takes for the company to resolve the claim after the injury. When a company consistently resolves claims quickly, it shows they dedicate time, energy, and resources to the process, instead of just shuffling paper.

Businesses should also look at how many claims result in litigation. A company with less cases going to trial means more attention to individuals, cases, and concerns.

Excellent Industry Statistics

The industry average for claims ending in litigation is a whopping 10%. Obviously, you’ll want to choose a company with a much better record. Claims costs increase dramatically when cases go to court.

For instance, Gilbert’s Risk Solutions’ TPA relationship sees only 3% of claims result in litigation – that’s 70% less than the industry average. When a company surpasses industry norms, it’s clear they communicate well and work hard to avoid conflict which translates to speedier, less costly resolutions.

You can also measure company effectiveness by comparing claims resolution in less than 90 days. The longer that claims drag on, the more costly they become and the more difficult it is to find satisfactory resolutions.

For instance, Gilbert’s Risk Solutions’ TPA relationship consistently settles 82% of claims in less than 90 days from the date the injury occurs. This statistic shows that our claims adjudication process is highly-efficient and cost-effective and that our team is made up of excellent communicators and negotiators.

Work Load

Many claims adjusters are too busy to do a good job. Look for a company with a low ratio of claims to adjuster so they have the time to investigate claims properly and can act quickly to control claims costs.

Our claims managers handle less than one-fifth of the industry average workload and each manager works on one account. Policyholders have a single point of contact, regardless of the size or severity of the claim.

Loss Prevention

Preventing losses is always preferable to resolving claims. Consequently, Gilbert’s Risk Solutions and our insurance carrier partners work together to identify injury causes. We can develop a plan and suggest changes so workers avoid similar injuries. Our three-pronged approach involves claims adjusters, loss control, and owners to create a safe, accountable work environment.

Gilbert’s Risk Solutions’ long track record and commitment to excellence minimizes risk and cost. We’re local and reliable and easy to talk to, so contact us to discuss your workers’ compensation claim needs.

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