There is more to getting compensation when a worker is injured on the job than just filing the claim. The workers’ compensation system in Pennsylvania is in place by law, but that doesn’t mean it runs on automatic pilot. There are many players and many facets to manage to get a worker back to wholeness of life and work. That’s one reason why having an attorney with particular experience in workers’ compensation issues can be so helpful.
Another reason is that while rightful demands for coverage and care are being made from the worker’s side of the table, employers are typically working just as fervently to cut workers’ compensation costs. They do this in any number of ways. Some may seek to delay claim payment by automatically denying initial claims.
For some in the workers’ compensation industry, the focus may be on trying to bring greater accountability. For many in this line of work, the lynchpin to success rests with the adjusters. They point out that the adjuster answers to nearly all the stakeholders in any given claim. There is the injured worker. There are the employers (those who care too much and those that don’t care a whit). And there are medical care providers (those who fail to report and those who bill more than they should).
When all those forces are in play, it’s understandable that an adjuster might look to find the easiest path to case closure. And the consultants say that when those routes are taken, costly mistakes happen and employers bear that cost.
In response to the issue, one consultant recommends that employers do more to make sure adjusters:
- Investigate every claim thoroughly.
- Look to spread the liability around to possible third parties.
- Thoroughly read all medical reports related to a claim.
- Be attentive to tips about possible fraud.
- Don’t abdicate their tasks to lawyers.
- Appropriately use medical case managers.
- Do a weekly review of each worker’s claim and return-to-work status.
The point to take away is that the system is complex. There are many stakeholders, each with their own agenda. The injured worker and delivery of workers’ compensation benefits should be the primary concern, but often the worker is the one with the least amount of legal representation. That doesn’t have to be.
Source: Amaxx Risk Solutions, “Know 8 Costly Mistakes Workers Comp Adjusters Make, Rebecca Shafer, J.D., July 5, 2011