Moore: An Important, Easy Task for Adjusters Has Disappeared

Thursday, August 12, 2021 | 0

One task that workers' comp claim files need has seemed to disappear over the years.  Most adjusters can make their lives much easier by accomplishing this one task upfront. 

James Moore

In the 13-point workers' comp adjuster everyday to-do list, this has to be the most important one except to pay weekly benefits.

The easy task that takes just a few minutes to accomplish is the three-point contact. Back in the 1980s and 1990s, not only was the contact required within 24 hours (even on Fridays), a recorded statement of the injured worker was an additional add-on task.

Some carriers and third-party administrators still require recorded statements. As always, and for any recommendations that I have given, check your claims manual on how to handle three-point contact.

Contacting the treating physician, employer and injured employee within 24 hours after receiving the first report of injury (FROI) will save time and avoid later headaches.

Of course, if the employee is represented by an attorney, one cannot contact the employee, but the adjuster can call the attorney’s office and at least talk to a paralegal or assistant. Some states do not allow contact with the physician without the employee’s permission.

Most adjusters do contact the employer, then send the worker and physician a letter.

Claim files: the most important key

The adjuster is the communication hub on the file. Making the three-point contact on any comp claim files may seem to be an overwhelming task with the other daily duties.

Establishing a working relationship with all three main parties on the file makes the case progress more easily. The initial three-point contact can help start the relationship. 

As I write this, I realize that adjuster turnover remains very high during the pandemic.  The turnover generates a time crunch to accomplish this task.

The best way that I recommend for contact is with email once the initial “hello call” has been made within 24 hours. This makes file documentation much easier without having to type a record of a phone call.

My 3-3-3 contact recommendation keeps things short and to the point.

How do I come upon the lack of three-point contact? When I review workers' comp claim files for agencies, carriers, TPAs, attorneys and state governmental entities.

If you have questions on how to accomplish the 24-hour contact, you know where to find me.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.