The Role of a Workers' Compensation Indemnity Adjuster

Introduction

Workers' compensation insurance is designed to provide medical and wage replacement benefits to employees who are injured or become ill in the course of their employment. When a worker files a workers' compensation claim, it is important for the claim to be properly handled and escalated to the appropriate adjuster if necessary.

Signs a WC Claim Should be Escalated

There are certain signs that indicate a workers' compensation claim should be escalated to a lost time/indemnity adjuster. These signs include:

1. Severe injuries or illnesses that require extensive medical treatment
2. Claims involving permanent disabilities
3. Claims that result in significant time off work
4. Claims that require vocational rehabilitation
5. Claims involving disputes or litigation
6. Claims that involve multiple parties or complex legal issues
7. Claims that require coordination with other insurance policies
8. Claims that have been denied or disputed by the employer or insurer

When any of these signs are present, it is best to transfer the claim from a medical-only examiner to a lost time/indemnity adjuster. This ensures that the claim is properly managed and the injured worker receives the appropriate benefits.

The Role of a Lost Time/Indemnity Adjuster

A lost time/indemnity adjuster is responsible for handling workers' compensation claims that involve lost wages or disability benefits. Their role includes:

• Investigating the claim to determine its validity and the extent of the injury or illness
• Coordinating with medical providers to ensure the injured worker receives appropriate treatment
• Evaluating the employee's wage loss and disability benefits
• Calculating the appropriate compensation for lost wages and disability
• Managing the claim throughout the entire process, from initial filing to resolution
• Working with the injured worker, employer, and other parties involved to reach a fair settlement

Lost time/indemnity adjusters play a crucial role in ensuring that injured workers receive the benefits they are entitled to under workers' compensation laws. They must have a deep understanding of the workers' compensation system and the laws and regulations that govern it.

Other Types of Workers Compensation Adjusters

In addition to lost time/indemnity adjusters, there are other types of workers compensation adjusters that handle different aspects of workers' compensation claims. These include:

• Medical-only adjusters: These adjusters handle minor medical claims involving simple injuries or illnesses that do not result in lost wages.
• Litigation adjusters: Litigation adjusters handle claims that involve disputes or litigation, including cases that go to court.
• Catastrophic adjusters: Catastrophic adjusters handle claims that involve severe injuries or illnesses that result in long-term or permanent disabilities.

Each type of adjuster has specific responsibilities and expertise in handling workers' compensation claims.

What Not to Say to Your Workers' Comp Adjuster

When you are injured at work and filing a workers' compensation claim, there are certain things you should avoid saying to your adjuster. These include:

1. Admitting fault or accepting blame for the accident
2. Exaggerating or downplaying your injuries
3. Discussing unrelated medical conditions or injuries
4. Providing inconsistent or misleading information
5. Refusing to cooperate with the adjuster's requests for information or documentation
6. Threatening legal action or making demands
7. Discussing the details of the claim with anyone other than your attorney
8. Posting about the claim or your injuries on social media
9. Ignoring the adjuster's communications or failing to attend scheduled appointments
10. Signing any documents or agreements without fully understanding their implications

It is important to remember that the adjuster is not your advocate and may be looking for reasons to deny or minimize your claim. It is best to consult with an attorney who specializes in workers' compensation claims to ensure that your rights are protected.

Conclusion

Workers' compensation indemnity adjusters play a crucial role in managing and resolving workers' compensation claims that involve lost wages or disability benefits. When a workers' compensation claim displays signs that it should be escalated to a lost time/indemnity adjuster, it is important to transfer the claim to ensure proper handling and the injured worker receives the appropriate benefits.