Blaming the Claims Adjuster: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Have you ever noticed how everyone seems to blame the claims adjuster whenever anything goes wrong in a file? It’s amazing how often it occurs. Let’s start with an injured worker who blames the adjuster for their injury, as if the adjuster somehow caused the accident. We know in reality the adjuster had nothing to do with it, but an injured worker often needs to blame someone. The claimant’s anger is therefore directed towards the employer’s representative, which in this case is the claims adjuster. To rationalize why the adjuster is to be blamed, injured workers come up with a variety of excuses. For example: The adjuster may be unreasonably blamed for refusing to authorize a non-certified medical procedure, found to be inappropriate by both utilization review and IMR.

It doesn’t end there. Judges have been known to unfairly blame adjusters as well. In a case we observed at the Board, a judge opened a file while commenting, “Let’s see what the adjuster did wrong this time.” Talk about being prejudiced. In another case involving an unrepresented worker, we watched as the two parties submitted settlement documents for judicial approval. While looking over the papers the judge snidely remarked, “Let’s see how many penalties I can find.” For goodness’ sake, the parties were there to amicably settle a case, but the judge preferred to focus on imaginary penalties, assuming the claims adjuster must have committed multiple errors.

It’s even worse when an employer blames the adjuster whenever there is a large settlement. It didn’t matter that a worker was seriously injured using a table-saw, where the safety guard had been deliberately removed by management, exposing a high-speed, sharp blade that sliced off four fingers. The employer blamed the adjuster for the high dollar settlement for failing to order surveillance. Well, we got news for that employer … “No amount of surveillance in the world will ever change the fact the employee lost four fingers.” The bottom line is the company refused to take responsibility for its decision to speed up production by removing a safety guard. They gambled with their employee’s safety and lost.

Claims adjusters should realize that no matter what happens in a file they will be blamed. Don’t take it personally. It’s okay. We understand and so does your employer. It reminds us of a T-shirt that says, “I didn’t say it was your fault. I said I was going to blame you.” Although it would be rather humorous to wear this shirt at work, we do suggest you fight the urge to wear it at the appeals board.