National Workers’ Comp Adjuster Day was August 17. Maybe today is a good day to remember that behind every claim is an adjuster who is a person, too.
Part 1: The Person Behind the Claim
An entirely fictitious story. The workload, however, may feel painfully familiar.
My name is Sarah.
I’m a workers’ compensation adjuster. Well, at least that’s what my business card says.
I was hired because someone told me I was organized, good with people and could learn quickly. Apparently, that was enough.
On my first day, I was handed a computer, a password, a stack of files and a brief explanation of where to find the coffee.
Then someone said, “Don’t worry. You’ll get the hang of it.”
I’m still getting the hang of it.
I have more claims than I can reasonably remember. More emails than I can read. More phone calls than I can return. More forms, deadlines, reports, notes, payments, medical records, requests, meetings and metrics than I ever imagined existed.
And somewhere in all of that, I’m supposed to help an injured human being recover.
To me, that’s the most important part, but it’s also the part I sometimes feel least able to do.
The Numbers
Every morning, I look at my dashboard.
How many claims are open? How many contacts did I make? How many bills did I process? How many files did I close? How quickly did I respond? How does my inventory compare with everyone else’s?
I understand why we measure these things. Someone has to make sure claims are moving and costs are warranted.
But sometimes I wonder what happens when the measurement becomes more important than the person behind the claim. Because I can make a claim file look like it is moving without actually helping the person attached to it improve.
And those are two very different things.
The Claim I Almost Missed
A few weeks ago, I had a claim involving a warehouse employee who injured his back.
The medical records said one thing, and the employer said another. The injured worker wasn’t returning my calls, and I had a dozen other claims demanding my attention.
So I left another voicemail. Eventually, he answered.
He wasn’t avoiding me because he didn’t care about his claim. He was scared. He was worried about his job and paying his mortgage. He didn’t understand what was happening with his medical treatment and, frankly, he didn’t trust the system.
That conversation lasted almost 30 minutes. Thirty minutes I wasn’t supposed to have, but it was probably the most important 30 minutes I spent that week.
For the first time, I wasn’t managing a claim.
I was talking to a person.
And once we talked, things started to change. He understood what was happening. I understood what he needed. His employer understood where the communication had broken down.
The claim started moving in the right direction. Those 30 minutes reminded me why I became an adjuster in the first place.
Then I looked at my workload, and reality came rushing back.
Here’s the Part Nobody Wants to Say Out Loud
I can’t give every claim 30 minutes. Not with my current workload.
I can’t call every injured worker just to see how they’re doing. I can’t always dig deeply enough into the medical records to understand the whole story.
I can’t always stop and ask: “What is really keeping this person from getting better?”
Sometimes I am simply trying to get through the day without something falling through the cracks, and I don’t think I’m alone.
There are adjusters sitting at desks all over the country who genuinely want to do a good job. Some are experienced. Some are brand new. Some received excellent training.
Others were handed a desk and told to figure it out.
Most are trying. Really trying, but good intentions don’t create more hours in the day.
Maybe We’ve Been Asking the Wrong Question
I’ve heard the question: How can an adjuster handle more claims?
Maybe the better question is: How can we give an adjuster more time to handle the claims they already have?
That’s where training matters.
A well-trained adjuster doesn’t just know how to process a claim. They know how to recognize red flags. They understand the workers’ compensation system and the importance of communication. They know that pain isn’t always visible. They know an injured worker’s behavior may be telling them something.
A well-trained adjuster can recognize when a claim needs a phone call instead of another letter, and they understand that two claims with the same diagnosis can have completely different recovery paths.
Training doesn’t just make adjusters more technically competent. Training gives adjusters the confidence to handle the human side of the claim.
Because Every Claim Is Different
I’ve seen simple claims become complicated.
I’ve also seen complicated claims resolve beautifully because someone took the time to understand what was really happening.
Two people can have the same injury and completely different barriers to recovery.
One may be worried about money. Another may be concerned about losing their job. Someone else may be afraid of getting hurt again, struggling to support a family, navigating a language barrier or simply not understanding what happens next.
The diagnosis might be the same, but the person isn’t.
That’s why every claim deserves to be treated as an individual story.
And that’s hard to do when an adjuster is buried beneath a mountain of files.
Maybe the Answer Isn’t More
Maybe the answer isn’t more claims, more metrics, or another dashboard.
Maybe, just maybe, the secret sauce is three fairly simple things:
Train adjusters well.
Give them reasonable claim loads.
Use technology to eliminate administrative burdens, not eliminate the human connection.
Imagine what could happen.
An adjuster who isn’t constantly playing catch-up and who has time to pick up the phone.
An adjuster who understands the system well enough to recognize when something isn’t right and who has the time to listen instead of rushing to the next task.
The result?
An injured worker who feels heard instead of processed.
And, perhaps most importantly, a claim that moves toward a quicker recovery instead of simply moving through a costly workflow.
I’m Sarah. Remember, I’m completely fictitious, but if you work in the world of workers’ compensation, you probably know people like me.
Maybe the next time we talk about improving claims outcomes, we should remember that the injured worker isn’t the only human being in the claim.
There’s another one sitting behind the desk who needs training, more time, and a little help.
That’s where our conversation gets interesting.
Technology, particularly artificial intelligence, is rapidly becoming part of the claims process.
The question isn’t whether AI can help an adjuster, but rather what we will do with the time it gives back?
Next week: Part 2, “AI Should Give Me Time, Not More Claims.”
