With a case load of 160 lost time claims, how does any workers comp claims adjuster have any time to ‘manage’ any case?
That’s the point Bob Kulbick, CMO at Cypress Care (HSA consulting client) made in a talk last week, a point I’ve been thinking about since that meeting.
The obvious answer is ‘they don’t’. There is no possible way an adjuster can dedicate the time and brain power necessary to effectively manage claims with a case load that high. And that is not an unusual case load – in fact most TPAs keep case loads well above 120. Even that load is excessive – it breaks down to about an hour a month per case.
Yes, an hour a month per case.
I’ll grant that some of those cases are old and there’s little going on – little except continued use of medications, in many cases physical therapy, and the odd surgery to repair an older fix or replace a surgical implant worn out by use or otherwise defective.
That is certainly not the situation with newer claims. Adjusters have to initiate the three point contact (actually four in most cases) within a predetermined time, set up the case, conduct an investigation into causality, establish liability, ensure reports are filed in a timely manner, determine the initial reserve, and coordinate with medical management.
Established cases require ongoing contact with case management, voc rehab, the injured worker, attorney(s) if represented, employer, and likely the injured worker’s family. Medical bills have to be approved, drugs authorized, surgeries and hospital cases ok’ed, voc rehab plans reviewed, and then discussed with management.
This just hits the highlights – there are dozens of other discrete tasks involved in the process of adjusting comp claims, tasks that take time, careful thought, and professional judgment.
All of which are going to be in short supply with a case load of 160 LT cases.
Here’s the message. Employers who buy claims adjusting services on the cheap will get exactly what they bargain for – poor quality from overburdened, frustrated, ineffective adjusters.
May
20
This may be true on the surface but if you look deeper into respectable clsims operations, you will find a good deal of support in the form of claims managers, supervisors, medical personnel and clerical people that you fail to account for in your brief summation. In most cases. you get exactly what you are willing to pay for. Many intelligent buyers pay for case loads of no more than 125.
Joe:
Your comments on adjusters caseloads and “what you pay for is what you get “rings loudly with me! I am a veteran adjuster having spent some 30 yrs in the management ( yes I said management ) of WC claims.
There is a cause and effect at play here.Very little is being done to grow new adjusters, the large carriers invest little in the training process. The days of road adjusting has all but died in the WC enviroment and the lessons learned in the field are events few adjusters today are likely to be able to say they have even experienced.
The value of skilled adjusting has seemingly lost its importance in the marketplace and has been driven to a commodity type purchase(wrongfully )so has the talent pool deminished.
Many of todays adjusters have risen through the ranks of the “claims” department and forced into a processing mode vs managing and impacting the outcomes of claims.
Gone are the days of single state adjusting .To be a good claims professional one needs to be proficient in the juris-the model of centralization and requiring a single adjuster to manage too many claims in too many jurisdictions only serves to further dilute the art and science of adjusting.
To those carriers and TPA’s that have kept the bar of performance obtainable by limiting caseload size , aligning complexity with skill set and spend time teaching their adjusting staff ,my sincere thanks for holding firm in the proposition quality in equals quality out.
Many adjusters lead stressfull day to day existances and have few personal career highs!
There are two things that must get more attention in the adjusting industry in general.First, claims excellance comes from developing skill sets that are the foundation for building good claims professionals.Secondly the purchasers of adjusting services should place the right level of importance on the value good skilled adjusting brings to art of total loss cost mitigation. Judging all claims services in large part by the per claim charge is so short sighted.You do get what you pay for..cheap claims fees usually means costly claim outcomes.Incenting your claims service partner to have good outcome goals is a excellant way to align expectations and deliverables.
Good claims management is part science and an art .Too many have set aside both these principals for the sake of being the “low cost service provider”.In the end who pays the price from this lopsided model?
Too all those adjusters who spend countless productive hours behind the desks and on the phones of the organizations they work for and who take pride in what they do..I commend you for staying the course!
Its time the industry takes a hard look at itself and get back to basics.To the buyers of such services ,rethink what you should be paying for and how you can incent your claims partner in a way that creates a win/win.
I worked as a claims adjuster for over 17 years and loved almost every minute of it. The last company I worked for was bought out 3 different times and the guidelines became so restricted that you couldn’t adjust your claims. My case loads were always 180 or higher and before I left my last company I had over 200 claims. Yes, all lost time. It was so stressful but that is what I thought I loved.
I now work for a PEO as their workers’ compensation coordinator and love it. My family is amazed that I actually have fun now and laugh. I don’t have the constant stress of worrying about the reporting, did I pay the claimant, did I pay the order from the work comp court and so on.
I recently attended a work comp seminar and saw my old boss and co-workers. I told them I missed claims handling. They were quick to remind that they have over 200 claims and are constantly reporting. And to top it off the Medicare guidelines! Okay, I realized I didn’t miss it. The adjuster assigned to our claims is always using excuses. She is an old veteran of claims but she shouldn’t make excuses just because I have been there and done that.
I think to some adjusters it pays the bills and to the adjusters like me it is something you love. I enjoyed helping the injured workers who were truly hurt or getting that denial I worked so hard on, building the strong relationships with my clients which some I still keep in touch!
To sum it up, it isn’t possible to adjust a case load of 200 claims unless you are working 24/7. And if your case load is 120 then you are bored and not even working a full 8 hour day!
Old adjuster I agree with you!
Well, I have to agree with what everyone has said. It is still surprising that the powers to be hear the song but do not know the words. As long as carriers look to the claims department as an expense line item and not as a potential profit center, i.e. looking for claims departments to save claim and expense dollars thus improving the bottom line, the story will never change. Even on open and closed file reviews, there is more emphasis on form completion than on claim content and claim handling. You could have saved the company thousands of dollars in claim handling but if you did not complete that one form, the file fails audit. That is teaching the wrong line of emphasis to new claims handlers and does not reward the talented and experienced claims professionals. Thus, talented claims people leave the business or find jobs elsewhere where there talents are rewarded. This normally leaves a vast talent pool unfilled!!!! I see no change in my 33 years in the business. It just seems to be getting worse. I hope for all the new adjusters, this changes so they can see what it is like to actually adjust claims and not process them.