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Comments from a claims adjuster - Long
#1
Greetings all.

I am a workers' compensation claims adjuster in Louisiana. I've been doing this for about eleven years. I sometimes refer to the workerscompensation.com section relating to the laws and statutes. I had never looked at the forum but the other day I decided to check it out, just out of curiosity.

I have to say, I am completely in shock at so many of your experiences with your adjusters! I work for a company that apparently is not the norm. It's a small office; five adjusters and a Manager. Our Manager has always instilled in us to do the right thing by the injured worker; both legally AND morally and by nature, all of the adjusters welcome the 'authorization' to do that.

In all of my eleven years and hundreds of claims that I've handled, it is very rare that I out and out deny a recommended course of treatment. Example: One of those denials was a request for Viagra for a fractured index finger. Due to the fact that the injured worker was not on any injury-related medication that would interfere with that 'ability' and the injury itself was not the cause of that 'condition'; well, it just didn't fit the 'reasonable and necessary' definition and, his physician, chosen by him, couldn't relate it. The injured worker had a great sense of humor and understood why I couldn't authorize it. But, that's my point. I've only denied those things that in no way, shape or form were related to the injury or through indisputable evidence it was learned that the injury was not work related and could not be covered under workers' comp. There have been several times that I've had the displeasure of learning, through a phone call from a relative, that the individual was faking an injury, was collecting wage-replacement (indemnity) benefits and was either working with friends for cash or had gone to work someplace else (even though their doctor said they were TTD). And, even in those cases, I didn't terminate benefits until I gave them and their attorney the evidence that proved the fraud and gave them numerous opportunties to voluntarily dismiss the claim so I wouldn't have to drag them (both the injured worker AND the attorney because the attorneys knew each one was a fradulent case) before the Court or press formal charges. Unfortunately, there ARE some that will be dishonest to some degree and that's just reality. Those few dishonest ones are irritating to me because they take valuable time away from me; time that needs to be spent on those legitimate claims in order to keep them running smoothly with as little inconvenience and disruption to the injured worker's life as possible, under the circumstances.

Unfortunately, a few bad apples can cause an adjuster to become jaded and suspicious of each and every claimed injury. I however, am not one of those adjusters. I've had many injured workers tell me that I was nothing like the horror stories they had heard about workers comp adjusters. After reading these posts, I see what they were referring to.

Those adjusters that are putting some of you through h**l, give fair, decent, compassionate adjusters like me a bad name and I am so disappointed that you all are being treated so unfairly by a system that was designed to help you when you had a work-related injury.

As an adjuster who works very hard on your behalf, it hurts to read on here that the majority of you despise 'me' and feel like I am walking evil. I assure you, not all of us are bad. Some of us truly do care and will go above and beyond to make sure that you are taken care of and receive the treatment you need and/or want so that you can return to your pre-injury condition or as close to that as possible.

And, as far as settlements go, for those claims that settlement is appropriate, not all adjusters will try to short-change you. Where I work, my Manager would kick us to the door if we even tried to give you less than what your claim is worth (fortunately, no one in OUR office wants to give you less). I had claim several years ago that was ready for settlement. The injured workers' attorney provided me with his evaluation and the number that his client would settle for - $80,000.00. I did my own evaluation; his client's claim was actually valued at $318,000.00. Only about $25,000.00 of that was medical as he only got one medication and saw the doctor once a year. Can you guess what I settled for? Yep - $318,000.00. Although his attorney wanted this all up front, (bigger fee) I didn't do that. Not because I'm mean. You see, this individual was an older gentleman who had dropped out of school in the 7th grade and did not have the capacity to effectively manage such a large sum of money. This money had to last him for the rest of his life because he couldn't work anymore. If he would have been given it all, he would probably have been broke within a year because I'm pretty sure he would have been generous to the people around him. I convinced his attorney that the right and MORAL thing to do would be to give him several years of indemnity in one lump sum to enjoy and then have the rest put into a trust that provided him with weekly checks for the remainder of his life. That way, he would have a guaranteed steady flow of funds that met his needs with a little extra.

This was a very long-winded message, I know. But, I just wanted to apologize to you for the way many in my industry is treating you. And, I wanted to clear my name, so to speakSmile

Take care.
 
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#2
way weird.

why would any of this be believable from an anonymous poster......
is your real name Linda May?
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
geez louise.....what a load of..... well BS....
........I love cats, I just cant eat a whole one by myself......







 
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#4
Something seriously doesn't sound right.

1171, I had almost forgot about Linda May.

I guess it could be.
8-05, Micro laminectomy/disectomy. 10-05 lumbar fusion L5-S1. 2-07 exploritory surgery. 12-07 medical implant, Spinal Cord Stimulator. now receiving SSDI. After going back to school, I received my degree as a mechanical engineer. What can I say, it was the only way I had to beat the system. 
 
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#5
1171 Wrote:way weird.

why would any of this be believable from an anonymous poster......
is your real name Linda May?

Wow, that certainly wasn't a response I anticipated. No, I'm not Linda May and I've never heard of a Linda May. My intention when I shared my personal philsophy of handling claims was that it would dispel the sterotype that all adjusters are the same - evil, cold, greedy, and that in and of itself, would somehow help someone on here feel better. Everything I wrote is the truth. My intentions were sincere but I now understand that my thoughts on the subject are neither wanted or respected. I also now realize that I wandered into enemy territory so I will leave you all in peace to discuss your cases and wrongdoings amongst yourselves.

Take Care.
 
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#6
GKelly Wrote:
1171 Wrote:way weird.

why would any of this be believable from an anonymous poster......
is your real name Linda May?

Wow, that certainly wasn't a response I anticipated. No, I'm not Linda May and I've never heard of a Linda May. My intention when I shared my personal philsophy of handling claims was that it would dispel the sterotype that all adjusters are the same - evil, cold, greedy, and that in and of itself, would somehow help someone on here feel better. Everything I wrote is the truth. My intentions were sincere but I now understand that my thoughts on the subject are neither wanted or respected. I also now realize that I wandered into enemy territory so I will leave you all in peace to discuss your cases and wrongdoings amongst yourselves.

Take Care.

I just got some popcorn made and now our leaving.....? This was about to get interesting, Who is Linda May..?
 
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#7
Bronco do a search on the forum for Linda May...



Well to the poster above if it walks like a duck. and it smells like a duck, and it looks like a duck then it must be a duck.
Cervical Fusion 2003, c5-c6. Herniated and damaged Disc L1- L4-L5 S1. Lumbar Spinal Cord stimulator implant 09-2008. Cervical ACDF revision with hardware c4-c5-c6-c7 Sept 2009.
SSDI approved 3-2010. NOW OFFICIALY RETIRED
 
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#8
GKelly Wrote:Greetings all.

I am a workers' compensation claims adjuster in Louisiana. I've been doing this for about eleven years. I sometimes refer to the workerscompensation.com section relating to the laws and statutes. I had never looked at the forum but the other day I decided to check it out, just out of curiosity.

I have to say, I am completely in shock at so many of your experiences with your adjusters! I work for a company that apparently is not the norm. It's a small office; five adjusters and a Manager. Our Manager has always instilled in us to do the right thing by the injured worker; both legally AND morally and by nature, all of the adjusters welcome the 'authorization' to do that.

In all of my eleven years and hundreds of claims that I've handled, it is very rare that I out and out deny a recommended course of treatment. Example: One of those denials was a request for Viagra for a fractured index finger. Due to the fact that the injured worker was not on any injury-related medication that would interfere with that 'ability' and the injury itself was not the cause of that 'condition'; well, it just didn't fit the 'reasonable and necessary' definition and, his physician, chosen by him, couldn't relate it. The injured worker had a great sense of humor and understood why I couldn't authorize it. But, that's my point. I've only denied those things that in no way, shape or form were related to the injury or through indisputable evidence it was learned that the injury was not work related and could not be covered under workers' comp. There have been several times that I've had the displeasure of learning, through a phone call from a relative, that the individual was faking an injury, was collecting wage-replacement (indemnity) benefits and was either working with friends for cash or had gone to work someplace else (even though their doctor said they were TTD). And, even in those cases, I didn't terminate benefits until I gave them and their attorney the evidence that proved the fraud and gave them numerous opportunties to voluntarily dismiss the claim so I wouldn't have to drag them (both the injured worker AND the attorney because the attorneys knew each one was a fradulent case) before the Court or press formal charges. Unfortunately, there ARE some that will be dishonest to some degree and that's just reality. Those few dishonest ones are irritating to me because they take valuable time away from me; time that needs to be spent on those legitimate claims in order to keep them running smoothly with as little inconvenience and disruption to the injured worker's life as possible, under the circumstances.

Unfortunately, a few bad apples can cause an adjuster to become jaded and suspicious of each and every claimed injury. I however, am not one of those adjusters. I've had many injured workers tell me that I was nothing like the horror stories they had heard about workers comp adjusters. After reading these posts, I see what they were referring to.

Those adjusters that are putting some of you through h**l, give fair, decent, compassionate adjusters like me a bad name and I am so disappointed that you all are being treated so unfairly by a system that was designed to help you when you had a work-related injury.

As an adjuster who works very hard on your behalf, it hurts to read on here that the majority of you despise 'me' and feel like I am walking evil. I assure you, not all of us are bad. Some of us truly do care and will go above and beyond to make sure that you are taken care of and receive the treatment you need and/or want so that you can return to your pre-injury condition or as close to that as possible.

And, as far as settlements go, for those claims that settlement is appropriate, not all adjusters will try to short-change you. Where I work, my Manager would kick us to the door if we even tried to give you less than what your claim is worth (fortunately, no one in OUR office wants to give you less). I had claim several years ago that was ready for settlement. The injured workers' attorney provided me with his evaluation and the number that his client would settle for - $80,000.00. I did my own evaluation; his client's claim was actually valued at $318,000.00. Only about $25,000.00 of that was medical as he only got one medication and saw the doctor once a year. Can you guess what I settled for? Yep - $318,000.00. Although his attorney wanted this all up front, (bigger fee) I didn't do that. Not because I'm mean. You see, this individual was an older gentleman who had dropped out of school in the 7th grade and did not have the capacity to effectively manage such a large sum of money. This money had to last him for the rest of his life because he couldn't work anymore. If he would have been given it all, he would probably have been broke within a year because I'm pretty sure he would have been generous to the people around him. I convinced his attorney that the right and MORAL thing to do would be to give him several years of indemnity in one lump sum to enjoy and then have the rest put into a trust that provided him with weekly checks for the remainder of his life. That way, he would have a guaranteed steady flow of funds that met his needs with a little extra.

This was a very long-winded message, I know. But, I just wanted to apologize to you for the way many in my industry is treating you. And, I wanted to clear my name, so to speakSmile

Take care.

Legitimate or not, I'm not sure but giving you the benefit of the doubt, THANK YOU!

My case has finally settled and my W/C adjuster was absolutely amazing, there are good ones out there. It has been a long road but thankfully I have not had to struggle with many of the issues that most of you here have had to struggle with.

I feel that my settlement was fair and completely within the W/C laws of South Carolina, I have received EVERYTHING asked for through the whole process. I'm now facing Voc. Rehab. and hoping for a new career that I will enjoy, actually earning money to assist financially while keeping my knee safe well into my future!!!

Ginger
Let us not look back in anger, nor forward in fear, but around in awareness!!
 
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#9
GKelly,

Your first post does seem a bit incredulous - particularly the 7th paragraph! But hey, saints (although few) do walk this earth. Like Ginger, I'm willing to give you the benefit of the doubt...so don't go.

Smile http://www.youtube.com/v/eX28BVuRrJg?fs=...&rel=0
 
Reply
#10
1171 is an adjuster and if he doesnt believe it..........
........I love cats, I just cant eat a whole one by myself......







 
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