Simple Concepts for a Complex System: Employers Can Make the Claims Adjuster's Job Easier

Examples of actions that increase the claims examiners workload, delays closure and impairs claims results include:  

• Employer hires an employee who is unqualified for the job, or retains a non-performing employee, and expects the clam’s examiner to help get rid of that employee. 

• Employer does not implement appropriate safety programs and then blames the injured worker for the injury. 

• Employer fails to immediately report all claims. (This is particularly true when the employer’s broker is used as an intermediary to report the claims). 

• Employer does not use the appropriate designated medical facility (In some jurisdictions employers do not have medical control). 

• Employer drops off an injured worker at an emergency room and tells the employee to not report the injury as industrial. 

• Employer fails to provide (or delays in providing) the necessary information needed to accurately calculate the correct benefit rates. 

• Employer delays the investigation process by not allowing the examiner to talk to the front-line supervisor or to any witnesses. 

• Employer provides an inaccurate job description with the physical requirements of the job to the treating physician, physical therapist, nurse case manager, or claim’s examiner. 

• Employer fails to provide light and/or modified or transitional return-to-work duties. 

• The employers’ front-line supervisor failure to maintain contact with injured worker who is off on disability. 

• Employer fails to provide notice to the examiner of any fraud red flags. 

• Employer, believing all claims are fraudulent, pushes for broader/deeper investigation when the injury is clearly compensable. 

• Self-insured employer does not provide adequate or timely settlement authority. 

• Employer (or their broker) focuses only on reserves when doing a file review rather than focusing on employee recovery, return to work, and claims closure. 

• Employers call the examiners every five minutes to get updates on the claims. 

• Employers who never acknowledge a good job, but constantly complain to claims leadership about the claims examiner. 

• Employers that make inappropriate peronal comments about the injured workers, including topics like  disability, race, religion, or sex. 

• Employers who lie about the job classification of the injured worker.  

• Employer does not attend a trial or deposition as a witness when there is a dispute. 

• Employer does not acknowledge the work put into a successful Arising out of Employment or Course of Employment defense.  

These bullet points identify potential shortcomings, but the list  can be turned into a checklist for positive actions.