Social Media Participants Air Concerns Over Loss of Adjuster Talent

The skills of claims adjusters may be a thing of the past. According to recent postings on the Work Comp Analysis group on LinkedIn, it ranked right along with increasing medical costs, keeping up with compliance changes, and fraud as major concerns of workers' comp participants.

The issue was posted in response to the question "What are the biggest challenges the workers' comp insurance industry is facing?" Several respondents outlined possible reasons and gave possible solutions.

"The adjuster has become a processer rather than an adjuster who investigates and mitigates the exposure," wrote Karen Rutledge, a regional account manager at HUB enterprises in Virginia. "They are there to meet the quota they have to meet."

Workers' comp veteran says adjusters are losing their edge (04/18/11)

Undocumented workers is a hotbed issue for employers (08/29/11)
Report outlines effective strategies for successful self-insurance groups (06/18/12)
Opt-out proponents seek to expand support through education (09/10/12)
Economy, legislative reform, aging workers highlight regional sessions (10/29/12)

With her experience as a former claims manager with a self-insured employer, third-party administrator, and large carrier, Rutledge said she has gained a wide perspective on the industry. "For those that are longevity employees, they are slowly losing their skills because to keep up with production numbers they can't keep up with investigations."

Reasons. There are many additional reasons claims adjusters may be less innovative than they once were. Industry veteran Angela Biggs says things were different when she began her career 22 years ago.

"Companies were willing to actually train back then," she said.

Another LinkedIn poster concurred, saying companies have largely stopped spending money on training and instead rely on coworkers and/or a supervisor to provide on-the-job training. He also said that increased caseloads among claims adjusters are often too high.

The workload for claims adjusters has become one of the dominating themes on workers' comp-related social networking sites.

"We all know it's way higher than it should be," said Robert Castro, account executive at Coast General Insurance Brokers in California. "People talk about 150 and below as a good number as long as you have assistance. The reality is I've heard of adjusters having 400 [claims] and getting 250 new claims and passing theirs off to somebody else."

Solutions. The blog posters expressed several ideas to help claims adjusters regain their innovation and expertise. Castro suggested a team effort -- "an adjuster, nurse, loss control/risk manager -- all working in tandem, all learning from one another."

Castro told WCR the team idea stems from his former days as a psych nurse. He would look at the big picture and incorporate the mental aspects along with the physical and medical issues when considering a patient.

"A nurse would triage [the claim] and pass on recommendations to the adjuster -- usually a medical-only adjuster, maybe a less experienced adjuster," Castro said. "We would outline a list of possible red flags for this injury to look for. . . . So, the adjuster had a qualified list of key problems to look for as he was working on the case."

Castro said by using the team approach, the adjuster could refer back to the nurse case manager. For problematic cases, the team would discuss whether to maintain the ongoing case management or send a case manager on-site to meet with the patient.

"All [participants] will be able to work their specialties while knowing each others' areas, at least to the point that each can recognize when it is most effective for the other to take the lead," Castro said.

Some bloggers believe there are pros and cons to a team approach. "I think there are obviously clear benefits in the sense that you can bounce ideas off one another," Rutledge said. "But again, there's the loss of talent -- you don't think on your own."

Rutledge believes a team approach would work if there are older, more experienced adjusters involved, rather than a group of all new adjusters. She believes another solution may also be starting.

"We're starting to go back to customer service and being focused on the customer, being attentive, picking up the phone and explaining the process, walking it through," Rutledge said. "That in itself lends the opportunity to go back to being creative and developing some of those skills that people are rusty at or never had. I think that's the start."

Read more at the WorkersComp Forum homepage.

April 18, 2011

Newsletter Sign-up