comes a primary defense if allegations of
bad faith claims practices arise.
2 They have an in-depth working knowledge of the workers’
The task of the adjuster is to fairly and
equitably apply the verbiage and tenets
found within the workers’ compensation
statute. Therefore, it is incumbent upon
the adjuster to understand the statute and
how it could be interpreted.
The claims adjuster should maintain
a paper copy of the statute for easy reference. Many adjusters learn about the
statue by word of mouth or from other
adjusters and legal counsel. While this
is helpful, it cannot replace first-hand
knowledge of the statute. An adjuster
who is not knowledgeable about the compensation statute will have difficulty applying it in a fair and equitable manner.
Likewise, exceptional claims adjusters
understand current case law and how it
applies to the management of their portfolio of claims. While not functioning as
legal counsel, claim handlers making decisions on behalf of an insured organization should have a working knowledge of
statutes and current case law. Such knowledge will complement the legal defense of
a claim when the factual scenario suggests
that an aggressive posture is indicated.
3 They promptly and accurately formulate and establish reserves.
Properly established reserves can have
a positive effect on the insured’s Workers’ Compensation insurance costs. (The
Sarbanes-Oxley Act and other financial
regulations require insurers and self-insureds to accurately document their liabilities). In order to promptly and accurately establish reserves, the exceptional
adjuster is well-trained, experienced and
employs reserving assistance software.
He or she is also fluent in the disciplines
Are You an Exceptional Workers’
Claims adjusting requires a broad base of specialized knowledge. Whether claims practitioners work in the property and casualty or life and health fields, they need
to know about law, contracts (policies), medicine, engineering and
construction. Workers’ compensation adjusters must also maintain
an intimate knowledge of medicine including orthopedics, neurology,
internal medicine and psychiatry. Additionally, they must have an in-
depth knowledge of law and statutory construction, human relations,
negotiations, underwriting and a smidgeon of actuarial science, and
they must be patient, inquisitive and composed.
Knowledgeable claims adjusters understand that they have a direct impact on
the cost of their insured’s Workers’ Compensation insurance. There are a number
of concepts that many exceptional adjusters practice in order to provide accurate
and timely claims handling.
1 They consistently refer to and follow prescribed claims
Good faith claims management and prop-
er reserving are paramount to the finan-
cial success of any workers’ compensation
program. Good faith claims management
is also critical to the fair and equitable ap-
plication of the workers’ compensation
statute as it applies to injured employees.
Defined claims management practices
and procedures bring continuity and
equality to the claims process. Workers’
compensation adjusters should consistently refer to their claims management
protocols, and insurance regulations in
many states require such guidelines. Furthermore, following such protocols be-