Workers’ Comp Adjuster/Carrier Complaints and What To Do About Them
The topic of this blog is not a common one for me as even though I deal with workers’ comp issues at times, particularly for after incident review and recommendations for preventing future occurrence. That being said, one service we provide does involve assisting work comp adjusters and/or employers determine the work relatedness of the injury and job fit accommodation of the injured employee for their original and any potential temporary transitional work positions. It is then that I hear employers complain about their adjuster/carrier. Unfortunately, most employers only complain but otherwise just sit back and watch as they think this is the way the all work comp carriers operate. Not true. If employers complain and nothing changes then you, the employer, have a right to demand better and if that doesn’t happen you must take the time and effort to search and find the right fit for the type of work comp program you desire.
Let’s take a look at some of the common complaints and options/responsibilities that employers may have to alleviate the situation:
· Adjuster doesn’t act fast enough
o Most employers think the adjuster has a few cases and has plenty of time to work on each one—wrong! An adjuster may have 200 or so files to work and your company’s files are in the same priority bucket—“get to it when I can”. An employer I talked to recently asked why it was taking so long for an employee to get an MRI. It was recommended by the doctor well over a month ago. The only answer I could give was that the adjuster was swamped and hadn’t gotten to it. If you want an adjuster to take a timelier look at your files, then you need to communicate with them.
· Adjuster doesn’t see the flashing red lights warning about the compensability of the file
o See above reason—they don’t have time to investigate the claim properly. Employer—do you conduct incident investigation analysis after each and every incident and near miss? If not, this is partially your issue as well.
· Always have a different adjuster for every case
o It is very uncommon to have a dedicator adjuster to a single company, unless your company has a very large account. However, this doesn’t mean that you can’t ask your carrier to have your claims handled by one or two adjusters so you always deal with the same two people every time. This is important as each adjuster has their own style of handling claims and communication.
· Adjuster is not aggressive enough and puts tons of reserves into each file
o Again this is related to the first complaint—adjuster not having time to work on the file. Unfortunately, most adjusters as soon as they see the report from the medical provider that states this is a work related injury assume this is fact and move on. This is where an employer’s investigation along with having accurate physical and mental demands of the job can be go a long way to determine if the story from the employee match the facts.
· Adjuster doesn’t listen to my concerns
o This again could be related to the adjuster’s workload, however, that is no excuse. Your adjuster should be listening to your concerns about the file and answer your questions. If this isn’t happening then you should go to your broker and express your displeasure. After all, you are a customer of your broker and carrier and as a customer you deserve to be listened to. If not, do what most customers do when dissatisfied…
· Adjuster didn’t bother to get work abilities and/or adjuster let the medical provider say the employee can’t do a specific task
o If this is the case, it is very costly for you and the carrier. If a worker is restricted from working or from doing a specific task, then you and carrier will pay out more money. If you have sedentary work available and if the employee is not post-operative or on required bed rest, then the adjuster should take the time to contact the medical provider and get the restrictions changed to reflect what the employee can do instead of what he/she can’t do. The sooner the employee returns to work will benefit you, the carrier and employee—less wage loss, less claim expense and the employee is more likely to return to their original position.
· I don’t know what’s going with my claims/lack of communication
o Again this may be due to adjuster workload. I would advise if this occurs that you make the effort to contact the adjuster and ask for weekly updates on your files and the specific information you expect from him/her. If the communication fails to happen let your broker know.
To summarize, there are actions employers can take if they are dissatisfied with their adjuster/carrier.
1. Take steps to minimize the injury risks of your jobs. If you have a high mod rate, is that the fault of your adjuster? I know this is tough to hear but blaming your employees or your adjuster won’t make the injuries go away. Do incident investigations, determine the root cause and implement corrective actions so likelihood of it happening again is reduced.
2. Contact the adjuster and let him/her know of your concerns. Ok, as in life in general, stuff can happen and work injuries can occur despite your best efforts. If your adjuster doesn’t listen and attempt to resolve the issues, then go to your broker.
3. Tell your broker of their issues and concerns. The broker should be an intermediary between you and the adjuster. If the broker is not able to resolve your concerns and is not presenting you with other options to resolve those issues then maybe it’s time to find a new broker and another carrier.
Do you have a file that’s going on too long? Do you need training and assistance in getting an after incident review process established? Contact us as we can help!