What Is the Ideal Workload for Workers' Compensation Adjusters?

In the insurance industry, an ongoing debate surrounds the quest to pinpoint the perfect workloadfor workers' compensation claims adjusters. Various stakeholders, including adjusters, insurers, third-party administrators (TPAs), and employers, each bring their unique perspectives to the table. They all have their opinions on the ideal number of claims an adjuster should handle. However, it's crucial to acknowledge that there's no universal answer to the question of how many claims are too many.

From the adjuster's standpoint, the goal is to maintain a consistent volume of claims that can be effectively handled without constantly firefighting. Adjusters do not want to be perpetually overwhelmed by excessive caseloads, as it hampers their ability to provide thorough attention to each claim. In such cases, failing to dedicate ample time to claimants can lead them to seek legal representation, unnecessarily inflating claim costs.

Furthermore, excessive caseloads hinder adjusters from conducting comprehensive investigations, potentially resulting in undeserving claims being approved, or unrelated medical expenses getting reimbursed.

When adjusters are overwhelmed with too many claims, mistakes are bound to occur, leading to what is commonly referred to as "leakage." Leakage refers to losses incurred due to claim inaccuracies or inefficiencies. These errors significantly contribute to the overall cost of workers' compensation for employers. However, insurers often avoid acknowledging the role of inadequate claim handling in rising premiums.

Even self-insured employers, who manage their own claims, struggle to determine the appropriate claims load for adjusters. Assigning a specific number to quantify caseload is often impractical because workers' compensation claims vary widely in size and complexity. For instance, a claim related to a finger fracture typically requires less time than one involving an amputated foot. Nevertheless, both claims are treated as a single entity when determining caseload.

Several factors influence the number of claims an adjuster can effectively handle. One crucial factor is the adjuster's experience. A seasoned adjuster with decades of experience can handle a more extensive caseload compared to a novice still learning the intricacies of workers' compensation laws.

The jurisdiction in which an adjuster operates also plays a significant role. Different jurisdictions have varying requirements, with some demanding extensive paperwork and others imposing strict rules for returning claimants to work. Moreover, certain jurisdictions are more prone to attorney involvement, which can significantly impact an adjuster's workload.

Another factor often overlooked is the industry of the injured employee's workplace. Industries with a high frequency of low-severity injuries allow adjusters to manage more claims efficiently compared to those dealing with high-severity injuries.

Adjusters also adapt to their workload, often learning how to manipulate claim counts. Instead of promptly closing cases, overloaded adjusters might delay the process to keep their claim numbers high, which can lead to further delays in receiving new claims to work on.

In reality, there is no precise number of claims that an adjuster should handle. While having a set number of claims may serve as a marker for workload management, a more effective approach for insurers and TPAs is to implement vigilant supervision. Engaged supervisors can review the adjusters' work, ensuring adherence to best practices while allowing adjusters to allocate their time effectively.

Measuring adjusters based on their performance, rather than the quantity of claims, leads to a reduction in mistakes, timely investigations, decreased litigation rates, lower adjuster turnover, enhanced employee cooperation, fewer employer complaints, and reduced financial leakage. Ultimately, this approach benefits employers by curbing future workers' compensation costs.

For employers unsure if their workers' compensation adjusters are managing an appropriate caseload, independent claim file audits can provide clarity. A claims auditor can assess the adjusters' workload, compliance with best practices, and the extent of financial leakage in claims. Seeking assistance in identifying an independent claims auditor can be a prudent step toward optimizing adjuster workloads and minimizing costs.

The question of how many claims an adjuster should handle lacks a universal answer. It's essential to recognize that various factors, including experience, jurisdiction, and industry, influence an adjuster's workload. Rather than fixating on a specific number of claims, a focus on performance and diligent supervision can lead to more efficient claims handling, ultimately benefiting employers by reducing costs and improving overall claim quality.