Adjusting WC Claims

[tcope]

I've been an adjuster for about 17 years now, handling all forms of business... except WC claims. I may be going to an interview for a new job handling those claims. They advertised it as a Liability Adjuster - Specialist. I had no idea it was going to be WC.

Can someone shed some light on how WC differ from other claims? I'd imagine the laws governing how the claims is handled and paid are going to be different. I think this would be the only real challenge for me as I know next to nothing about them (what qualifies a person, when payments need to be made, etc). I also don't know how the whole "settlement" thing works (I thought months payments were made but I guess some claims are settled an closed?).

I'm not looking for every aspect of the job... just wondering if someone might be able to provide some insight to a person who know just about every line of business... except WC.

[1171]

there is no one answer as each state is different. each state has it's own specific laws that control benefits, eligibility, and legal appeals.
workers comp is highly regulated and can be extremely complex. some states offer training courses in different aspects and many states require certification before you can adjust claims under their jurisdiction.
you should contact the state's insurance department or workers comp agency for information on their requirements.

[admin]

http://www.workcompresearch.com

In case you get the job. You'll want the 50 state Compliance Center we have in there. Good luck.

[tcope]

What I'm really wondering is how WC adjuster differs from a general liability adjuster. As I see it a WC adjuster deals almost exclusively with the injury itself and doctors notes. What I'm used to is taking the loss, determining what policy applies, determining the coverage under the policy, investigating the loss (which is the big part) and then settling the claim. I see WC as more oriented toward health insurance.

I don't know why this company advertised this as a Liability Specialist position. No where in the ad did it mentioned WC. Two different animals.

I also don't know why they even called me as I don't mention WC anywhere on my resume. Their ad was geared toward wanting someone with at least 7 years liability experience. I would have _LOVED_ to work for this company... but its a little like hiring me to built space rockets.

[tyson]

Working with workers' compensation claims is challenging yet rewarding. The employee helps injured workers receive compensation and treatment for their injuries. It is a very specialized task; each state has specific rules about how to handle a claim.
* Applies knowledge of Workers' Compensation Laws, both statutory and judicial in adjusting workers' compensation claims.
* Studies and implements applicable changes in Workers' Compensation Laws, Rules and Regulations.
* Investigates claims and potential claims against insured's for Workers' Compensation; determines appropriateness in accordance with Labor Code.
* Gathers, organizes and analysis data, reports and other documents to determine compensability and establish evidence.
* Determines or evaluates liability and sets monetary reserves within limits.
* Negotiates and approves settlements within prescribed limits, makes recommendations to the customer's risk manager and excess carrier for all amounts in excess of established authority, obtains and prepares Compromise and Release or Stipulations with request for award.
* Pursues third-party recovery from at-fault parties and ensures the customers right to third party credit when applicable.
* Denies claims in the proper manner where investigation has established that liability against customers does not exist.
* Represent customers before the Workers' Compensation Appeals Board.
* Corresponds with medical and legal professionals in an effort to resolve claims issues.
* Interprets medical reports and suggests appropriate treatment.
* Works with defense attorneys to prepare suitable defenses for contested cases.
* Obtains and reviews workers' compensation job analyses to evaluate an injured employee's ability to return to regular or modified work.
* Determines return to work process for injured employees based on medical information obtained by the adjuster.Real Estate Marketing
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