The Other Side of The Claim: Mental Health Challenges for Workers' Compensation Adjusters

Written by Sandy Avina

I remember the first time I cried as an adjuster. I had just gotten off the phone with a woman whose husband had fallen two stories down an elevator shaft. Miraculously, he survived the fall, but his injuries were the most significant I had seen. I had received his claim a few weeks prior and had already started disability benefits and assigned a catastrophic case manager. His wife had missed several days from work to be by his side at the hospital.

They had a 6-month-old baby, and she had just returned to work a few weeks before his accident. She was terminated for missing too many days from work and didn’t qualify for FMLA. “Is there anything else you can do to help us?” I explained the disability benefits, and that medical treatment would be covered, but I was afraid this was such a small and hollow offering against the enormity of her fears. She was sobbing. I could hear her baby crying in the background.

Behind every workers' compensation claim lies a hidden toll on the adjusters who, witnessing the aftermath of injury and disability for injured workers, face their own mental health battles arising from compassion fatigue.

What is compassion fatigue?

People whose professions lead to prolonged exposure to other people's trauma can be vulnerable to compassion fatigue, also known as secondary or vicarious trauma; they can experience acute symptoms that put their physical and mental health at risk, making them wary of giving and caring. (Psychology Today, 2024)

Why is it important?

Compassion fatigue affects our industry in two ways: First, claims adjusters already face tremendous demands in their jobs. Our industry is struggling to recruit and retain the next generation of adjusters, which means adjusters in their current roles are likely facing high caseloads and understaffed departments. Adding compassion fatigue to the existing demands of the job is a recipe for burnout.

Second, the helplessness adjusters feel when they are handling particularly catastrophic injuries contributes to compassion fatigue. Adjusters can become jaded, reducing their ability to empathize. It’s not that adjusters want to be unfeeling, but many disengage as a self-preservation method. This results in a poor experience for the injured worker, who relies heavily on an adjuster to provide communication, patience, and guidance as they navigate the challenges arising out of their disability.

WHAT CAN WE DO?

Support from the industry

Third Party Administrators, insurers, and vendor partners have an opportunity to partner with non-profits and advocacy groups to identify and consolidate information on public resources: food banks, discounts on public transportation, free or low-cost mental health resources, free meals for children at public libraries, etc. Injured workers and their families often seek assistance from adjusters on how to deal with impacts from their disability that fall outside of the scope of workers’ compensation benefits. Having a resource page on the company website will help prevent adjusters from feeling helpless when injured workers approach them with questions related to needs and support outside of workers’ comp. This helps injured workers identify solutions for some of the challenges resulting from their disability.

Support for Claims Leaders

Claims leaders need to be trained on how to identify precursors to compassion fatigue and burnout among their adjusters. Adjusters should be advised and encouraged to completely disconnect when they are off work. Discourage adjusters from providing vendors, attorneys, clients and injured workers with their personal cell phone number. Our industry is notorious for this practice, and it is not sustainable. Claims leaders should be experts on their company’s Employee Assistance Program (EAP) and reference it regularly in meetings with their team.

Support for Adjusters

Several claims training programs cover the statutory component of claims handling: calculating disability benefits, determining compensability, addressing disputes regarding treatment authorization, etc. Here’s what’s missing: how to manage the social-emotional component of claims handling. Do adjusters know how to handle a call when someone is crying? How about if someone mentions self-harm? If they are assigned a claim that deals with a particular trauma, they have experienced themselves, do they know they can have a conversation with leadership to discuss possible reassignment? These topics should be included in any comprehensive claims training program and provided as an annual refresher to all adjusters.