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  • John Larrimer

What Is the Role of a Workers’ Comp Adjuster? | All You Need To Know Before Your Work Comp Hearing

When a worker gets injured at work, the employer(s) and their insurance company will assist them in getting compensation. Specifically, they will assist the worker get the necessary medical care and lost wage benefits.


If a worker wants to get compensation, they must file a compensation claim. Unfortunately, filing a compensation claim involves plenty of paperwork. That means there is a chance the worker may forget some documents that are important. It is smart to get the help of Columbus work injury lawyers so they can help guide you in the right direction.


Luckily, the workers' compensation adjuster steps in to assist the worker in gathering the necessary documents. These documents give more information about the employee and their injury, which helps them to process the claim.


The workers' comp adjuster will process these documents after doing their investigations. They investigate by asking the employer and witnesses how the worker got injured.


There are other roles that workers comp adjusters play. Here are other ways they assist the injured worker(s).


Other Roles

Other Roles


People expect workers comp adjusters to automatically assist the worker in getting compensated. However, they can also reject a worker's claim if they are vague. An example of a vague claim is saying that the worker fell. They will need to know how the worker fell exactly.


After all, not all falls are related to work. If a worker cannot explain how they feel, they may assume the worker is clumsy and reject their claim.


Another role workers' comp adjusters play is approving treatment or medication. After approving the worker's medical care or treatment, they settle the hospital bills through their insurance company. Also, they may compel the employer to settle the bills.


It is not enough for workers' comp adjusters to ensure a worker gets treatment. They must ensure that doctors' reports follow the American Medical Association (AMA) guidelines. According to the guidelines, a doctor's report should not contain defamatory information.


Also, they should ensure doctors' reports do not use profane language. Lastly, the reports should not contain private information about the workers, such as email addresses and cell phone numbers.


Workers comp adjusters must be aware of the laws guiding workers' compensation. That is because parliament may change the laws at any time. If they follow old guidelines, they would technically be doing something illegal. Also, understanding the current laws helps them issue notices to workers and insurance companies whenever necessary.


Skills Of Workers Comp Adjusters

Skills Required by Workers Comp Adjusters


After discussing the roles they perform, it is imperative that we discuss the skills they should have. These skills will enable the worker to know whether or not they are dealing with a competent workers' compensation adjuster. Also, identifying the skills will help aspiring worker comp adjusters know what skills they require. It is also a good idea to know what you cannot do while on workers comp.


(a) Analytical Skills

Analytical skills involve searching and interpreting information. By having these skills, they can make informed decisions. These skills enable them to determine whether an injured worker deserves compensation. If the expert wrongly compensates a worker, that will translate to losses for the insurance company.


(b) Attention to Detail

Having this skill helps workers comp adjusters spot any error on the claim. Sometimes, there could be a miscalculation of the compensation. Miscalculations mean they may overcompensate or under-compensate a worker.


This skill is also applicable when viewing personal details about a worker. If there is a typo in a worker's name, it can be hard to process the claim. That is because other insurance workers may assume the misspelled name belongs to someone else, not the injured worker.


(c) Communication Skills

Obviously, people need these skills in every profession. However, some people do not realize how crucial the skills are. Workers comp adjusters require these skills to keep the workers informed constantly. That means the worker should not be caught off guard when they discover information that the expert did not tell them.


Also, under these skills, they should be good listeners. Remember, not all workers are good at expressing themselves. Some workers provide unnecessary details pertaining to their injuries. The workers' comp adjuster must discern helpful information for the claim.


(d) Problem-Solving Skills

A workers' comp adjuster must not only solve the problem but do it on time. If they delay solving the problem, there may be conflicts between the worker and the company. When a worker reports their injury, the expert should quickly identify the cause of the injury. After knowing what caused the injury, the expert will resolve the issue immediately.


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