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Moore: Advocacy Model vs. Workers' Comp Adjuster Goals

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I recently attended a webinar provided by the National Workers' Compensation and Disability Conference where some of the adjuster goals were compared to the expectations of claims management.

James Moore

James Moore

Two of my favorite workers' comp people, Rachel Fikes, of Rising Medical, and Denise Zoe Algire, of Albertsons, led the event. Those two ladies have always been kind and gracious to me at all times, especially in person.  

I had written multiple articles pleading with adjusters to fill out the surveys to voice the claims staffs’ opinions on what their goals were during the process of a claim. 

You can sign up here to listen to the webinar. It's totally worth it if you are in a claims office or if you have any interactions with workers' comp adjusters.

The shocking part was the congruence (similarity) between claims management expectations and the workers' comp adjuster goals. Slide 6 had the top competencies alignment between management and the claims staff. 

You will need to register to listen to a recording of the conference and to obtain the slides. Please do listen to it; take the time. 

The conversation in the webinar focused on:

  • Alignment of frontline staff perspectives with those of claims leaders surveyed in prior years.
  • Assessment of job meaningfulness.
  • Ranking of company benefits that frontline staff most value.
  • Adequacy of new hire and senior staff training.
  • Ranking of core competencies and key practices most critical to claim outcomes (the one I am covering today).
  • Assessment of technology and data’s impact on job performance.
  • Understanding of advocacy-based claims models.

Frontline staff rankings

  1. Compensability investigations.
  2. Disability and return-to-work management.
  3. Medical management.
  4. Claim resolution and settlement strategy. 

As one can see, these are the steps to “getting the claim off my list.” I could possibly be too “old school” in my views, but this is what I always hear from any adjuster I speak with presently. 

If one opens up any workers' comp claims manual, the above four are major headings. The survey was spot-on to ask those questions (good job).

Yes, we all want to make sure injured workers timely receive every penny they are owed. Many states are now ratcheting up the investigations and fines for sloppy or late adjuster benefit actions (payment, filing forms, etc.).

Adjusters want to naturally provide benefits timely. Some of the state-enacted COVID-19 presumptions made adjusting staffs look like draconian claim deniers. Very unfortunate.  Occupational disease statutes have long taken care of claimants when a disease has been contracted on the job. 

Did claims management and workers' comp adjuster goals align?

As with any survey, the opportunity to dig deeper exists. I hope to see that the question of workers' comp claims management and adjuster goals has a further explanation. 

Good job. The survey and results production required a ton of hard work. 

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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