Many workers compensation carriers have several teams of adjusters. These usually consist of medical only adjusters, lost time adjusters, and so on. From time to time I see a high exposure claim team, where if a reserve is over a certain point it gets transferred to a team and they take it from there. Some carriers will even employ a team of what they call “General Adjusters (GA).” The role of the GA is usually to handle very high-exposure severe injury claims or complex injury claims.
But what is the rationale and “class” behind certain labels of adjusters and what does this mean? Why are some adjusters good at one level, then not so great at another level? Why are these classes of adjusters even there?
The medical-only adjuster
This is the lowest rung of the adjuster ladder. Fresh to the business, this adjuster is just breaking into claims at the lowest exposure level. This adjuster will handle simple claims. These injuries are minor cuts, scrapes, burns, and so on. The worker either treated on the jobsite with first-aid, or had a few trips to the occupational clinic. There is no lost time away from work, and no compensability issues. These adjusters have a very high case load, and the file turnaround time is very fast. Little investigation is completed, and it will consist of contacting the employer to get injury details. These adjusters are just learning the business, the case law, and the rules of claims 101. It is here where you will see if an adjuster is organized, and if they will remain in the business on a long term basis. The phone work involved can be heavy, but the complexity is minimal. Usually this adjuster will handle the tasks of their desk for a period of months to a few years, before deciding if they want to take the next step in their career. If the med only adjuster dislikes this job, this is where they will bail out and look for new employment.
The lost-time adjuster
This adjuster is the common adjuster assignment. The tasks range from compensability issues on an injury, to some wage loss on injury claims. Injuries include minor to medium complex surgery, and most injured workers recover with no permanent disability. The file counts are high, and some claims can last up to a year before they either end, or are transferred to the GA team or the litigation team. Most adjusters in this role have been in claims a while, and handle the job just fine. However there is limited room for creativity, and most lost time adjusters are just going through the motions. They deal with reserving, with some perspective towards future exposure. Most of these adjusters want to take the next step towards the GA or litigation team, but for whatever reason maybe failed to do so. This could be because they lack furthering educational requirements, or they simply feel “picked-over” for some interoffice political reasoning. Usually adjusters in this role on a long-term basis have a cynical view towards claims in general, and this will show to their management. Perhaps they have not been dedicated to advancement of their own careers, and they are comfortable just going with the flow. These long-term lost time adjusters avoid conflict with their management on claims, and on the surface are fine doing whatever management tells them. But if you ask them, they always have an excuse as to why they are not chosen to the GA or litigation team.
The litigation adjuster
This adjuster is viewed as having the easiest job within the adjusting team ranks. Once a petition or hearing notice is filed on a denied or disputed lost-time claim, the file then transfers to this adjuster. They will assign counsel, and will work with the attorney on getting settlement achieved. This adjuster should have good relationships with defense and plaintiff counsel, and good knowledge of claim law within multiple states. They also have good vendor network contacts for vocational rehab, IME vendors, surveillance vendors, and so on. These adjusters are usually fairly savvy, and their caseloads are not too high. These adjusters have been in this spot for a long time, and they do not want to take the next step up to the GA team because it involves more work and more headaches. They are making a decent salary, and have a good thing going. Some carriers will even have these adjusters go to the hearings, mediations, and so on. This time out of the office is a treasure, and this adjuster also will have a good working relationship with insured. Litigation adjusters are almost always former lost-time adjusters, but rarely could be a former practicing attorney. Every now and then they were a former GA adjuster that couldn’t cut it.
The General Adjuster (GA) AKA the High-Exposure or catastrophic (CAT) adjuster
This is typically the highest adjuster rung on the ladder. This adjuster will handle severe cases involving serious fall injuries, limb amputation, prosthetics, multiple-surgery on multiple body part claims, paralysis, severe burn exposure, and so on. Every bad injury you can dream of will land in the lap of the GA. Each carrier will have a single GA or a team of GA people. These adjusters see the worst of the worst, and the claims are around for years. The goal of the GA is to forecast reserve exposure, with the overall goal of closing the claim on a full and final basis if possible within that jurisdiction. This adjuster usually handles multiple states, and is knowledgeable of case law within each jurisdiction. This adjuster has decades of experience, and has been though each rank of adjusting. Some are former managers who got bored with the routine of reviewing lost-time files and needed more action. This adjuster has a working relationship with each injured worker, with the hope of gaining their trust in order to help steer their treatment in the right direction. They will also handle complex litigation that is over the head of the normal litigation adjuster, due to the multitude and scope of the injury. The GA has to think outside of the box, while still walking the line of doing what is right. These adjusters are on the path for upper-level management if that is their goal, while some remain in the GA role until the end of their career. They make a good living financially, have an interesting role within the company, and each day can bring up different tasks. An effective GA will have a manageable caseload, since each file brings about certain challenges and requirements that cannot be decided on a whim. If you love a challenge, and have the experience, this is the job for you.
Author Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. http://reduceyourworkerscomp.com/about/. Contact: mstack@reduceyourworkerscomp.com.
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