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A workers' compensation claims adjuster analyzes workers' compensation claims review documents before authorizing payments. The adjuster examines the documents forwarded by the employee and determines whether they genuinely need compensation and the right amount.
Furthermore, the claims examiner reviews the claim to ensure the adjuster and employee follow proper guidelines and workers' compensation laws.
How Does One Become a Lost Time Adjuster?
Becoming a worker's compensation lost time adjuster requires a bachelor's degree in finance, business, insurance or a related field. The person must also have strong analytical and mathematical skills.
Other requirements to become a lost time adjuster may include the following:
State insurance adjuster's license
Criminal background check
Fingerprinting
The work requirements for adjusters vary by state. Lost time adjusters may work for insurance companies, state government offices, or human resource departments of corporations.
What Does a Lost Time Adjuster Do?
When injured at work, the insurance company ensures that workers get the necessary medical care and lost wage benefits. A lost time adjuster facilitates and coordinates the workers' compensation claim.
The primary role of the adjuster is to ensure that the employer and the insurance company adhere to the workers' compensation law while saving both money in the best way possible. Thus, they always aim to lower the cost of the claim as much as possible.
Duties of the adjuster include:
Investigating claims, including recording a statement from the injured worker
Determining whether the claim is to be rejected or accepted
Coordinating the worker's appointment with the doctor
Approving medical care
Determining how much the claim is worth and discussing the settlement options (Can I get disability after workers comp settlement.)
Talking to witnesses with information about the accident
Gathering information from the employer about what happened
What Kinds of Injuries Require a Lost Time Adjuster?
Lost time adjusters are experienced in local legal statutes and medical training to handle occupational claims. They usually handle claims past 90 days involving severe injuries such as:
Surgical repairs
Complicated lacerations
Pending surgeries
Level two or three strains
The adjuster verifies the workers' compensation claim after the employer questions the worker's right to compensate. A claim remains valid until the claimant is released from care or the claim goes into dispute. It may last months or years to settle. Also, find out if you need workman's comp as sole proprietor.
Getting a Statement from the Injured Employee
An adjuster will ask the injured worker to record a statement and ask questions about the accident and the injuries. These questions may include the following:
What the worker was doing before the injury
Whether there were witnesses to the accident
If the worker went to see a doctor right away
The kind of medical care received
The recovery period the doctor recommended
The injured worker also has to fill out an accident report with the employer, highlighting what happened and what part of the body was injured. Before recording a statement with the adjuster, the worker signs an authorization allowing the insurance company to record his medical information.
What to Avoid While Talking to an Adjuster
Lost time adjusters ask injured employees various questions regarding the accident and their injuries. However, they are on the insurance company's side and try to lower the claim's value as much as possible.
The adjuster may misreport the employee's words to make the injury less severe. Insurance companies may use this in their favor to discredit the validity of the compensation claim or to reduce its value.
Injured workers must understand that adjusters are working in favor of workers' compensation insurance companies. Therefore, they need to hire an attorney to help avoid making costly mistakes when dealing with the lost time adjuster.
Importance of a Workers’ Compensation Attorney
Injured workers are not obliged to talk to a lost time adjuster when uncomfortable. However, they can do so with assistance from an experienced compensation attorney. The workmans compensation attorney in Columbus will have the experience to know what to say and what not to say to the adjuster.
Work With an Attorney Today
At Larrimer & Larrimer, we have a professional and experienced team to help deal with a lost time adjuster. We offer legal advice on handling workers' competition claims so workers in Columbus, Ohio receive the compensation they are entitled to after getting injured on the job.
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