Moore: Claims Adjusting: It's Over in 48 Hours

Tuesday, January 26, 2021 | 0

Workers' comp claims adjusting for new claims is over in 48 hours. I know, it sounds like a bold statement. The old paradigm used to be 24 hours. I am giving the adjusters a break.

James Moore

Many of my webinars and presentations on handling claims by employers and the claims staff always come with a warning: As Roy Orbison sang, it’s over.  

Check out this article on the 48-hour time clock. Most of the links were written at least 12 years ago. 

The 48-hour timeline

My Six Keys to Saving on Workers' Comp follows the same timeline. The steps are:

• The employee has an accident. For employers, are injury reporting procedures in place? If not, an expensive delay has already occurred; the adjuster has not seen the claim yet. 
• The employee reports the accident. Does the employer have procedures for reporting an accident?
• The claim is filed. The injured employee seeks out medical treatment. The workers' comp claims adjusting process has not started yet. Medical control of the file has already been established by the employer and employee.
• The adjuster receives the claim. He contacts the employer, treating physician and injured employee — if the claims staff performs the critical three-point contact.   
• The first report of injury may be on the adjuster’s screen after the 48-hour time frame. That is why ASAP remains the best way to obtain and keep control of the claim throughout the process. 

The injured employee has reported the claim, sought medical treatment and may be off work by the time the first report of injury is received by the claims adjuster. 

Workers' comp claims adjusting vs. first impressions

The employee has already interacted with the employer in reporting the claim. The claims clock ticks away. 

The important part: The injured employee has already judged the workers’ comp process firsthand. He has already developed a positive or negative attitude by going through the process.   

The claim is 48 hours old. Every part of the adjusting process will not really change the claim. First impressions count.    

Over the years, I realized why my first claims manager would go ballistic if the three-point contact was not made within 24 hours, even if the claim came in on a Friday afternoon. 

One saving grace comes from Workers Comp Research Institute studies. The one component when looking back on the claim after the resolution was the trust of the employer by the employee. 

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.