“A workers’ compensation adjuster is not a paper pusher.” That’s one of “60 Tips for Superior Claims Handling” issued as part of a panel discussion held at a past National Workers’ Compensation & Disability Conference. “Work comp claims are more difficult than general liability claims. If you think of them as a paper pusher, that’s the output you’ll receive.”
Numerous articles make clear the impact of adjusters’ experience, skills, and judgment on claims outcomes (For example, see “Good Adjusters Know When to Settle Your Workers Comp Claims.”) Nonetheless, as indicated by the fact that panelists felt it necessary to make the point that adjusters are far more than back-office clerks, the misperception persists.
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Searching for a critical email, multiple browser windows open, bills to review, reports to write, lawyer and medical professional consultations, voice messages that came in while on other calls. It’s all part of the daily routine for claims adjusters. Add outdated claims management software, disparate systems, and manual or paper-based processes to the mix and productivity can suffer. The work backs up. In some cases, the potential for burnout is all too real.
“Adjusters normally deal with a high volume of cases, and each case can be emotionally draining,” writes Katie Dwyer in the January 2018 Risk & Insurance article Improving the Claims Experience. “The customer on the other side is, after all, dealing with a loss and struggling to return to business as usual.”
“At some TPAs,” adds Dwyer, “adjuster turnover can exceed 25%.”
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Origami Risk’s 2018 User Conference, held last week, utilized a new format that not only placed a premium on client presentation of use cases, but also focused on digging into “how” presenters managed to implement their specific solutions. Listening to a diverse set of cases, several common trends emerged.
1. Transparency is key
Many of those presenting echoed the need to establish transparency and accountability in their processes. You can’t measure what you can’t see, and you can’t improve what you don’t measure. The most obvious culprits were paper-based procedures—everything from workplace safety “coaching cards,” to incident intake reports. Spreadsheet-centric workflows, such as data-heavy values collection efforts, also failed to identify the “who, what, when, and where” type of information required to make any process fully transparent.
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A good workers’ comp claim adjuster is a master of coordination. Managing 100-125 open claims certainly stands as proof. Yet, caseloads alone hardly tell the complete story.
For newly assigned claims, information must be collected from the employee, employer, and medical provider. Reserves must be established and reviewed for accuracy. There’s regular follow up with claimants, nurse case managers, attorneys, and other stakeholders. Compensability reviews. Evaluation of settlement opportunities. Mediations to attend. And that only begins to scratch the surface.
Yet according to the Accenture white paper “Claims at a Crossroads,” claims professionals can “spend nearly half their day on activities that do not impact the outcome of the claim.” While those administrative activities may be necessary components of the process, that time is better spent engaged in activities—such as those cited above—that fully leverage the adjuster’s talent and experience, keep claims moving on the path toward successful resolution, and increase the likelihood of outcomes that benefit both employee and employer.
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The solid work of a supporting actor can make or break a film. And while it’s possible for great efforts to be underappreciated, there’s at least the possibility of recognition. When it comes to controlling claim costs, claims audits rarely, if ever, get the credit they deserve. They can (and often do), however, play a critical role in measuring and improving the overall effectiveness of claims programs.
“Many property and casualty (p&c) carriers have not yet examined how to enhance claims operations to reduce costs,” writes Gary Jennings in Why Auditing Is A Springboard To Cost Reduction. “Claims audits are an efficient and cost-effective method for evaluating how well a program has been structured, developed, and maintained.”
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Experienced adjusters are typically experts when it comes to understanding the nuances of a particular jurisdiction’s (or multiple jurisdictions’) workers’ compensation indemnity benefit laws. This can contribute to an efficient claims adjudication process and accuracy when determining the indemnity benefits owed to an injured worker. Will experienced adjusters be able to keep up as your business expands into other jurisdictions? What about less experienced adjusters?
Add to this the fact that the common practice of using spreadsheets to calculate both average weekly wage (AWW) and indemnity benefits is both time-consuming and risky. Not only is it necessary to keep up with the changes jurisdictions make to rates and regulations, but given the complex formulas involved, errors can be easily introduced and quickly proliferate.
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The clock is always ticking on workers’ compensation claims. Delays at any point in the claim lifecycle can contribute to claims remaining open longer and compound their cost. Taking a close look at the procedures and best practices used by adjusters—to determine where the potential for delays can be significantly reduced, if not eliminated altogether—is essential to reducing the cost of claims and improving outcomes.
In a recent post, we looked at how the Origami Compliance Forms & Correspondence solution contributes to a more efficient and accurate approach to workers’ compensation reporting. Realizing improved efficiency and accuracy in the processing of state forms is a major step in the right direction. Answers to the following questions should also be factored in: … read more
What stands in the way of a more efficient claims administration process? For too many organizations the answer to that question is a reliance on disparate systems, including the use of outdated legacy claims management systems.
The adoption of an integrated, SaaS claims management system that combines workflow automation tools with all of the functionality needed for end-to-end claims adjusting can be transformative. … read more