A Line-Item Breakdown Adjuster turnover tends to get filed under human resources. That is a mistake. When a trained claims adjuster leaves your organization, the financial damage does not stay in the HR budget. It spreads across your loss ratio, your reserves, your litigation rate, and your claim duration numbers. It shows up everywhere except the place where you were looking. CFOs and VPs of Claims routinely underestimate the true…
I am not sure why this popped into my head, but I was thinking about a song from the mid-80s from Dire Straits, the song “Money For Nothing” in the first line (and I will take the creative license with the lyric) “Money for nothing and your ‘checks’ (my bad) for free.” It seems a frequent consideration that a percentage of work comp claims are perceived as being embellished, fraudulent,…
The numbers on adjuster turnover are not surprising once you see them. What surprises CFOs is the calculation they have never run: the full cost of losing and replacing a trained workers compensation adjuster, compared to the cost of keeping one through structured professional development. The research is consistent. The Society for Human Resource Management estimates that replacing a mid-level employee costs between 50% and 200% of annual salary. For…
Litigation in workers’ compensation is often discussed as if it were an external force. Advertising trends. jurisdictional differences. social dynamics. All of those factors play a role. None of them are where most claims actually change direction. Litigation is rarely random. It is a downstream effect of earlier decisions. If you want to understand what fewer attorney-involved claims mean to your loss ratio, you have to start with a simple…
In our professional careers within the workers’ compensation ecosystem, how many times have we seen the most straightforward injury or claim file become one of the most problematic scenarios imaginable? The reported injury is relatively simple: a warehouse employee missteps and sustains an ankle inversion event, resulting in a modest ankle injury. The initial clinical evaluation included plain radiographs, which revealed no fractures or other osseous abnormalities. Given the findings…
It has been my experience that most C suite executives assume initial and ongoing training for workers compensation claim file handlers is a “discretionary soft expense.” This determination is incorrect and deserves a second look. An individual who is not trained, making significant decisions often produces measurable and avoidable claim cost inflation. I would like to ask each of you to run one additional calculation before you reach a final…
As a claim file handler in the workers’ compensation ecosystem, you and your team are not merely passive administrators of the noted claim. It is my belief you have a fiduciary responsibility to apply every aspect of the statute, working in the interests of both the injured employee and your client the employer. Essentially, you as the claim file handler, are the gatekeeper for medical interventions, financial accuracy, and adherence…
In general, individuals are responsible for their own healthcare. This includes taking measures to maintain their own health, such as following a healthy diet, getting regular exercise, and seeking medical attention when needed. In many countries, including the United States, healthcare is also considered a shared responsibility between individuals, healthcare providers, employers, and government entities. Employers may provide healthcare benefits as part of an employee’s compensation package, and governments may provide…
In every encounter in our practice within our Worker’s Compensation ecosystem, each interaction is modified by our personal experience. During my career pursuing cost-containment measures within Worker’s Compensation, two of the most dreaded words were “lumbar fusion.” The issues related to lumbar fusion often included persistent pain, long-term disability, and significant changes to the lifestyle of the affected employee. Personally, I have a long history of chronic low back pain,…
As a workers’ compensation professional, one of the ongoing challenges is assessing whether the recommended interventions are clinically appropriate, medically necessary, and will genuinely help the injured person return to work with maximum medical improvement. Certain decisions are entirely suitable for the requested treatment. A slip and fall in a 63-year-old individual resulting in a comminuted fracture of the femoral head clearly requires surgical intervention to include total hip replacement…
