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Comments from a claims adjuster - Long
#21
welcome back.

one of things you'll notice after reading a number of posts are that, in general, there is more in common with most work comp jurisdictions then then different.
also most of the issues injured workers bring are not the procedural details but basic concepts:
can I leave the state while on comp?
do my benefits stop if I change jobs?
what happens to my claim when the doctor can't do any more?
etc.
you also probably have a fair understanding of the AMA guides and many states use them for permanent impairment.
impairment rating is a total mystery to most.
you can probably research information far better because of your experience. there is a lot of online information (except for a few states like Louisiana) that gives the particular details of a states rules and regs so you are not really expected to have detailed knowledge of every state system.

please stay around. read some posts and help us with your insight.
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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#22
GKelly Wrote:
1171 Wrote:you're incredulous that you don't have instant credibility with strangers.
a mighty presumptuous 3-post wonder ...

you appear more like a self-proclaimed celebrity preacher that gets upset when there is not a rush to hear the golden words.

stick around a while and give some assistance to the many dozens of those that need help.
Earn your stripes here before climbing this pulpit.

actions and experience count far more then a one post and good intentions.

with me, your approach was all wrong.
start slowly and lets see what you can add to the board.
then you
will have made your point far more effectively.

Hmmm...

I see your and the other's point. I hadn't looked at it that way. Thank you for explaining where I erred. However, I must protest the phrase, "self-proclaimed celebrity preacher"; I'm not nearly that flashy and I don't wear that much blingBig Grin.

Thanks for the offer to stick around and assist but I'm not sure what I could offer in terms of the w/c laws. The only jurisdictions that I'm experienced in are Louisiana State and Longshore and I haven't noticed any members from those areas.
 
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#23
1171 Wrote:welcome back.

one of things you'll notice after reading a number of posts are that, in general, there is more in common with most work comp jurisdictions then then different.
also most of the issues injured workers bring are not the procedural details but basic concepts:
can I leave the state while on comp?
do my benefits stop if I change jobs?
what happens to my claim when the doctor can't do any more?
etc.
you also probably have a fair understanding of the AMA guides and many states use them for permanent impairment.
impairment rating is a total mystery to most.
you can probably research information far better because of your experience. there is a lot of online information (except for a few states like Louisiana) that gives the particular details of a states rules and regs so you are not really expected to have detailed knowledge of every state system.

please stay around. read some posts and help us with your insight.

I'd be happy to!
 
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#24
so enlighten some of us with the workers comp laws in louisiana...what workers copm insurance do you work for in louisiana?
 
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#25
that is none of our beeswax
........I love cats, I just cant eat a whole one by myself......







 
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#26
Hummmmm! Very entertaining, to say the least.

My feeling is that every I/W's story is different. No two IW's or injuries are the same and cannot be compared or lumped into a step-by-step claims examiner's instruction manual. We often lose what was to be the most important thing in our life; our careers and health.

The same holds true for Claims Examiners. They are individuals and each one different. The company they work for may set a standard to follow; either good or not so good. But the bottom line has to be in keeping costs as low as possible or I forsee your job would be on the line.

I really like that 1171 has said about gaining credibility with us.

So hopefully you can stay and comment and help. Looking forward to getting to know you better.
Let Go, and Let God......
 
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#27
I have to say that I think some were too quick to jump on this person. I've seen injured workers come in here with outrageous stories that include being abducted by aliens (with assistance from Elvis), and they have been immediately accepted at face value.

It's a shame that we do not extend professionals the same courtesy, and in this case even other professionals lead the charge. I am glad that you have managed to steer it to a seemingly positive result.

1171 was correct, the levels of suspicion here really require a gradual entry into the pool, as cannonballs tend to create a wake. GKelly, welcome to the forum. Our site really does serve everyone with an interest in comp. About 70 to 75% are employers and professionals like yourself who use our news, blogs and legal information. About 20% are injured workers, and you've stumbled into their home here. This is primarily where they reside on the site. I will add my voice to those asking you to stay and lend your expertise.

They are a touchy bunch, a bit temperamental at times and obstinate as well.... Nothing a good smack in the head won't fix, but there are great people here, and we are very proud of our forum. We'll be proud to count you among us.
 
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#28
GKelly thank you for staying on the forum.
 
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#29
(12-11-2010, 12:10 AM)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.
 
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#30
(10-29-2015, 12:58 PM)Queenbee1960 Sweet story. No one who has ever had to go through the workers comp nightmare believes this for one minute. Our experience has been outright lies, and numerous attempts to disqualify the recommendations of one of the best neurosurgeons in the state. The nurse case managers are a disgrace to their profession. You can\t have any ethics and be a part of this. She has been caught in several lies, she is incompetent to the point that she calls us to verify doctors appointments and even which doctor we are seeing. EVERYONE at workers comp is there for one reason. To keep the insurance company from paying legitimate claims. Our nightmare will hopefully soon be over, with the help of great attorneys. Be assured I will have some choice words for this "so called nurse. Nice try though! I hope  she has the joy of dealing with this herself someday and I hope the latest lie (advising us we were cleared for surgery when we had not been) gets her fired. Wrote:
(12-11-2010, 12:10 AM)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.
 
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