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What It Is Like to Be a Workers' Compensation Claim Adjuster

Updated on November 24, 2020
caseymel profile image

I was a Workers' Compensation Adjuster for five years. Here is my experience.

Workers' Compensation Adjusters normally work in cubicles

Workers' Compensation Adjusters normally work in cubicles.
Workers' Compensation Adjusters normally work in cubicles. | Source

Working Conditions Of A Workers' Compensation Claim Adjuster

Workers Compensation Insurance Adjusters work during normal business hours. They usually work in cubicles in an office setting.

Work Comp Adjusters sit for long periods of time and are on the phone most of the time with clients, attorneys and medical offices.

Work Compensation adjusters use a phone, headset and computer to do their job.

Adjusters no longer need file cabinets since all files are electronic.

Investigating Workers' Compensation Fraud

Three Levels Of Workers' Compensation Adjusters

There are three levels of Workers' Compensation Adjusters.

As you move up a level in your job as a Work Comp Adjuster, you will handle more severe injuries.

Workers' Compensation, Medical Only - This is the entry-level Work Comp Adjuster. Medical Only Adjusters handle simple claims that do not involve lawyers or settlements. The claims are for simple injuries like sprains, strains, cuts, bruises and the like. The Workers' Compensation, Medical Only Adjuster will pay for the medical bills of the injured worker until the workers' condition is back to normal.

Workers' Compensation, Level 2 Adjuster - Level 2 Adjusters handle more complex claims that require surgery, time off of work and longer care for the injury. Level 2 Adjusters have higher limits on the amount they can pay per injury.

Workers' Compensation, Level 3 Adjusters - Level 3 Adjusters handle the most complex claims. These work injuries result in death, disability and/or insurance fraud. They have the highest limits on claims and they deal with attorneys for both the worker and the insurance company.

As you move up in levels, you also move up in pay, but you also have a lot more responsibility.

Cubicle Work

Cubicle Work
Cubicle Work | Source

What Does A Workers' Compensation Claim Adjuster Do?

Since I worked as a Workers' Compensation, Medical Only Claim Adjuster for 5 years, I will explain what a day as a Medical Only adjuster is like.

The work day is a normal 8 hours long.

I would normally receive an average of 12 claims a day.

As you move up in levels, you will receive less claims, but it will take longer to work on each one.

I would get on my computer and check my inbox to see what I received overnight or over the weekend.

My inbox would contain: new Workers' Compensation claims, medical bills, medical notes and other miscellaneous information concerning the claims.

New Claims - I would normally begin setting up the new claims. I had 24 hours to set up the new claims. To set up a claim, I needed to review the information I received about the accident, set limits on how much I would pay for each claim depending on the type of medical care the patient needed and the severity of the injury. I would make sure all the patient/worker's information was correct and I would look over any other information I received and record it into my notes for the claim. I would call the employer to gather more information, verify the information I already had and ask if they were questioning the incident. New claims would come in throughout the day and I would set them up as I received them.

Medical Notes - I would then review the medical notes. Each medical note would be divided up into the Subjective, Objective, Assessment and Plan (SOAP notes). I mainly focused on the Assessment and Plan. The Assessment was the Doctor's assessment of the patients medical condition. The Plan was the Doctor's plan for getting the patient back to his normal condition. I typed the Patient's Assessment and Plan into their notes to keep track of the information I was receiving on their claim.

Medical Bills - Afterwards, I would review the bills and either pay them myself or send the off to our medical payment department. To pay a bill, I would have to verify that the medical code (ICD-9 or CPT codes) matched the patients injury. I also had to make sure the patient was not over-treating for his condition. This usually happened with Chiropractic care. Once I verified that the medical bill was related to the work-related injury, I would pay it.

New claims, medical bills and medical notes would come in throughout the day to create a steady, fast-paced stream of work.

Office Meeting For Continued Education

Office Meeting For Continued Education
Office Meeting For Continued Education | Source

Continued Education For Workers' Compensation Adjusters

Each year, Workers' Compensation Adjusters need to complete a certain amount of hours of continued education/training to keep them up-to-date on the latest Workers' Compensation information.

Training was provided by our employer in the office during normal working hours which was very convenient.

Is a Workers' Compensation Claim Adjuster Career right for you?

If you enjoy office work, being on the phone most of the day, typing and investigating you will most likely enjoy working as a Workers' Compensation Claim Adjuster. Workers' Compensation

Claim Adjusters normally make anywhere from $30,000 - $45,000 per year. As you move up in levels, you will normally make $5,000-$10,000 more per level.

Seniority also helps bring your salary up.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2013 Melanie Casey


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