A claim administrator is often the one standing between your company and major lawsuits. The claim administrator is responsible for addressing workers’ compensation claims as they come in. Their responsibilities can range from payment of compensation to scheduling of medical appointments for injured workers. Whether you work with a third-party administrator or a self-administered insurance carrier, ensuring your claim administrator is properly trained and supervised is essential to avoiding costly lawsuits.
Providing proper supervision of claims administrator is essential. Supervision of claims administrator has been a key issue in a number of litigation cases, from class actions regarding civil rights to personal injury litigation. As one example, Judge U.W. Clemon (retired Northern Alabama district judge) was among many who presided over complex cases involving supervision of claims administrators during his tenure. His cases have ranged from complaints against insurance companies to discount retailers and breast implant producers.
In 2006, he presided over a case of insurance premiums and the supervision of claims administrator in racially disparate insurance claims. In the past year, as many as one-third of black Americans report experiencing discrimination. For 50% of them, this discrimination occurred in the workplace or voting booth. Proper supervision of claims administrator to ensure any claims of employment discrimination are addressed fairly and promptly can help ensure your employees feel respected and heard.
The same applies to personal injury cases, up to 96% of which are settled pretrial. For employers, this means less time spent tied up in court and more time in production. In order for a personal injury claim to be settled pretrial, however, your claim administrator needs to be able to effectively and efficiently address claims is they come in.
To improve your claim administrators efficiency, it can be tempting to have adjusters specialize in one area. It’s true specialization can make for adjusters who are exceptionally efficient in their given area, but it can also leave them without adequate knowledge to make broader decisions. For instance, a workers’ compensation adjuster with no experience handling patent litigation may lack the expertise to recognize what information is needed to evaluate a claim’s value in intellectual property disputes.
Whether you opt to have your adjusters specialized or given a broader scope of expertise, providing adequate training is imperative. Adjusters should receive informal training from supervisors through regular reviews in addition to their formal training.
Supervision of claims administrator is essential, particularly when on boarding new adjusters and administrators. A supervisor should be someone who has already worked as an adjuster for a reasonable tenure and thus understands the ins and outs of the role. Experience alone is not enough to make a person an adequate claims supervisor, however. While spending time training any new claims adjusters, also ensure you provide adequate training for your new supervisors.
Supervisors should provide meaningful feedback after reviewing claims by adjusters they supervise. Comments left in claim file audits should be detailed as opposed to simply stamping “OK” or “reviewed.”
This should trickle up the chain of command, from claims supervisors to claims managers and the claims director. For a claims administrator to work at its optimal level, all parties must be properly trained. If you aren’t sure what areas of your training could be improved, consult with the members of your claims department. The claims director and claims manager may be able to identify training topics from their reviews of supervisors’ and adjusters’ audits. Likewise, the supervisor who conducted the audit and the adjuster who handles individual claims should be able to identify areas where training is lacking.
At the end of the day, lawsuits are trying. In too many cases, inadequate supervision of claims administrator has come into play. To prevent your company from being among the ones on dockets of judges such as Judge U.W. Clemon, ensure your claims administrator is properly trained and supervised.