Issues Complicating the Claims Handling Process

Workers’ compensation claims handling can be extremely complicated, especially in California. The session at the California Workers Comp & Risk Conference in Dana Point titled “Lets Get Ready To Rumble” focused on discussing a variety of issues that make a difficult situation even worse.

The panel consisted of Bill Goldstein – Wells Fargo, Robert Rassp – plaintiff attorney, Jake Jacobsmeyer – defense attorney, Jeff Pontra – Gallagher Bassett and moderator Jeff Pettegrew – Insurancethoughtleadership.com.

The issues discussed during the fast-paced 45 minute session included:
* Poor communication with injured workers, which is seen as the leading reason that these workers retain an attorney.
* A lack of trust between all parties in the system.
* Applicants attorneys who are not focused on resolving disputes and moving issues toward resolution.
* High adjuster turnover which causes a lack of continuity and direction on the files.
* Lack of preparation before hearings including securing proper settlement authority.
* Reserves that are inadequate for the probable exposure which results in failure to devote appropriate resources or extend proper settlement authority.
* A system that is more focused on the process than the common goals of getting the injured worker proper medical care and returning them to work.
* Unreasonable expectations by multiple parties, including injured workers over-valuing their expected settlement and employers who overestimate their chances of prevailing on disputed issues.
* Over utilization of UR which results in costly disputes over inexpensive medical treatment that the adjuster should have the authority to use common sense on and authorize.

Although there were a variety of viewpoints on the panel, all were in agreement that these obstacles are significant and extremely difficult to overcome. The thought is that there are inherent flaws in the system that must be addressed in order for it to function more efficiently and effectively for all parties involved.