Adjuster Selection Process for Self-Insured Employers: What Medical Tourism Facilitators Should Be Aware Of

You may recall back in November of last year, I wrote a fictional case study about how a self-insured employer who is self-insured for both group health and workers’ compensation, could implement medical tourism into their workers’ compensation program after talking to the benefits manager. Well, for those medical tourism professionals who are interested in working with self-insured employers to implement medical tourism for their injured workers, this week’s article post will give you a little idea of what goes into the process of handling workers’ compensation claims from the employer’s point of view.

Rebecca Shafer, an attorney and expert in workers compensation cost containment, wrote blog piece in Workers’ Compensation.com about how an employer can go about selecting the right kind of claims adjuster to handle their workers’ compensation claims.

Shafer said, that self-insured employers with successful workers’ compensation claim management programs know one key fact – the better the adjuster, the lower the claim cost. Whether the self-insured employer has dedicated and/or designated adjusters at the third party administrator, or utilize their own in-house adjusters, the selection of the best adjusters can be tricky.

She also stated that there are four primary attributes the self-insured employer should look for in the adjuster selection process. These are:

Communication

Documentation

Proactive

Courteous

Communication, Shafer says, should be open…between the adjuster and the employer…Open communications allows for the exchange of information about the claim and ideas on how to assist the injured employee while moving the claim forward. Open communications with the adjuster is not for the employer to micro manage the claims, but to facilitate collaboration and claim progress.

Documentation means that the best adjusters thoroughly document their files. Each phone call, e-mail, medical bill, medical report, attorney letter, state filing, etc., should be documented either in the file notes, the documents section of the file, or both.

Proactivity means that the proactive adjuster will coordinate and manage the medical care either directly or through a nurse case manager. The proactive adjuster will arrange for the employee to return to work light duty. And, the proactive adjuster will coordinate all other aspects of the claim before there is a need for action.

Courtesy extends not just to the employer, but to the employee as well. Other attributes an employer should be aware of, Shafer states, are the following:

Negotiation skills

Organizational skills

Time management skills

Customer service skills (customer being both the self-insured employer and the injured employee)

Work ethic

Ability to prioritize competing demands

Compliance with Best Practices

Technical expertise

As these are attributes that a self-insured employer needs to look for in a claims adjuster, it is not necessary for the medical tourism facilitator company to get so involved with the process of adjuster selection, only to be aware of what the employer will do to find the right individual to handle their workers’ compensation claims. In the event that medical tourism becomes more involved in workers’ compensation, and it is necessary for the facilitator to guarantee that the injured worker will be treated appropriately, it is incumbent upon the facilitator to understand the process of adjuster selection so that no misunderstandings or confusion over who is who, and what role they play in treating and caring for the patient. Knowing what it took to select the adjuster who may need to consult with the facilitator or the medical provider will make the medical tourism experience beneficial for all concerned.

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This entry was posted in Claims Process, Medical Tourism, Workers' Compensation and tagged , , , , , on by .

About Transforming Workers' Comp

Have worked in the Insurance and Risk Management industry for more than thirty years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. Have experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. Received my Master of Arts (MA) degree in American History from New York University, and received my Bachelor of Arts (BA) degree in Liberal Arts (Political Science/History/Social Sciences) from SUNY Brockport. I have studied World History, Global Politics, and have a strong interest in the future of human civilization in all aspects; economic, political and social. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. LinkedIn Profile: http://www.linkedin.com/in/richardkrasner Resume: https://www.box.com/s/z8rxcks6ix41m3ocvvep

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