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Claims management is a vital aspect of the insurance industry that requires a delicate balance between the interests of policyholders and insurance companies. With over two decades of experience in this field, I have had the privilege of witnessing the evolution of claims management while working with insurance organizations of all sizes and managing claims on the side of the policyholders. I will share insights gained from my experience, focusing on claims management, claims resolution, and emerging trends in the worker's compensation industry.
The variety of experiences obtained has given me a unique perspective on how the intricacies of claims management differ based on the size and complexity of the organization. While smaller firms may have a more personal touch, larger organizations often require more structured processes and advanced technologies to handle a higher volume of claims effectively. One of the core aspects of managing workers' compensation claims involves a multifaceted approach that includes conducting thorough investigations, assessing compensability, and ensuring that injured employees receive appropriate medical care. It also extends to facilitating early return to work, which is crucial in helping employees regain their pre-injury status. To be an effective claims handler, an Adjuster must be an effective and responsive communicator. The Adjusters are responsible for conducting three-point contacts with employees, employers, and medical facilities, ensuring that claims are handled with precision and professionalism. "While smaller firms may have a more personal touch, larger organizations often require more structured processes and advanced technologies to handle a higher volume of claims effectively" There must be collaboration with internal and external resources to resolve claims effectively. Workers Compensation Industry Trends: As we all know, the COVID-19 pandemic has had a profound impact on the insurance industry, particularly in the realm of claims management. One significant trend I’ve observed has been the increase in longer disability claims related to the virus. With employees experiencing extended periods of illness and recovery, the dollar amount of the claims has risen substantially. Adjusters are now required to spend more time navigating these cases, which often involve complex medical considerations and evolving health guidelines. They are asked to decipher the ongoing need for treatment and prolonged disability. Along with the complex medical issues, there is a surge in litigated claims. As a result, Adjusters are now more frequently involved in legal proceedings, necessitating a robust understanding of legal and negotiation skills to achieve fair and favorable outcomes. Conclusion: Over the past two decades, I have witnessed the ever-evolving nature of the insurance industry, which has caused Adjusters to become more knowledgeable and savvier in the medical and legal field of claims management. Therefore, to be successful, Adjusters must continue ongoing education, work with compassion, and have a passion for managing workers' compensation claims. It is essential to stay agile and adapt to emerging trends while providing quality service in an ethical manner.