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  1. #1
    Join Date
    Jul 2010
    Posts
    148

    Default Change of Adjusters for a Workers Compensation Claim

    My workers compensation claim was made in the State of: DC

    I just found out that my case has been moved to another adjuster. This is the fourth time in 13 months. I know there is no normal in WC but has anyone had this kind of hand off in such a short time...meaning 13 months on comp. is relatively short for serious injuries. I am just curious about other peoples dealings with this issue. I would like to say its one of the reasons it take so long to get anything done....but that just seems like their standard operating procedure.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,943

    Default Re: All My Adjusters

    Any CA in the office handling your claim should be able to adjust and pay benefits. One or twenty..doens't matter.

    Whether the ER is legally self insured, or covered by a liability policy be a carrier, the laws require an "administrator" to handle claims.
    Under/working for the Adm, are the CA'/Claims Adjusters, or CE's/Claims Examiners.

    I had about 3 CA's during the first 6 mo of my claim. There have been over 10 since 1997. Some stay longer than others.
    Some are trainers, once the trainee is able to perform the job functions of a CA, they take over the claim.
    None of this is cause for a delay... the ER/IC liabilitiy is why there are delay/denials in a claim.

  3. #3
    Join Date
    Mar 2011
    Posts
    291

    Default Re: All My Adjusters

    complain to your employer; it's their insurance policy and their carrier should respond to them about it's practices.

  4. #4
    Join Date
    Jul 2010
    Posts
    148

    Default Re: All My Adjusters

    That was kind of what I figured. I really hope I don't see ten adjusters. And like many IWs here my employer really couldn't care less.

  5. #5
    Join Date
    Apr 2011
    Location
    Washington, DC
    Posts
    54

    Default Re: All My Adjusters

    It's only been 10 months for me and already I've had to CA's. I didn't even know that I was assigned another CA until I received another letter of determination in the mail!

  6. #6
    Join Date
    Jul 2010
    Posts
    148

    Default Re: All My Adjusters

    I never got any notice that they were changing CAs but I can log on a website that show payment history and current CAs name. They just changed it again....thats number five. It does seem to effect response time a little. NCM #2 has told me several times they are shifting my case around.

  7. #7
    Join Date
    Apr 2011
    Location
    Washington, DC
    Posts
    54

    Default Re: All My Adjusters

    What website is that, I would love to have it so that I can better monitor whose handling my case?

  8. #8
    Join Date
    Jul 2010
    Posts
    148

    Default Re: All My Adjusters

    the website is mygbclaim.com but your info. will only come up is your claim is being handled by Gallagher Bassett. They are a third party administrator, they are not a IC from what I understand. My employer has a workers comp. policy with a insurance company, when I was hurt my ER said they were considering it to be a catastrophic injury and that is where the TPA comes in. Gallagher Bassett handles the claim for them. If you do a little research you will see that Gallagher Bassett in a nationwide company and they pride themselves on being the hired guns of "loss prevention" which boils down to useing every trick in the book to cut your throat and save dollars. So even though your claim may be through a different IC than mine, Gallagher Bassett could still be the TPA. Its worth going online to look. I also did some reading on Gallagher Bassett and turns out they have a very high turnover rate due to crappy workplaces, heavy case loads and low pay. Good luck.

  9. #9
    Join Date
    Apr 2011
    Location
    Washington, DC
    Posts
    54

    Default Re: All My Adjusters

    Ok, thank you!

  10. #10
    Join Date
    Nov 2012
    Location
    California
    Posts
    14

    Default Re: All My Adjusters

    Based solely on past experience, I will state that most insurance companies have multiple adjusters who handle claims, each depending on the level of the claim. The newest of adjusters take the initial claim, statements etc. Then if it appears to be a small claim it might go to an adjuster with a little more experience and a low settlement authorization. If the claim is a bit larger, or if it appears to be getting larger it will go to someone with a bit more experience. It the claim appears to go to surgery, still another adjuster gets it. if the Dollar reserves hit a certain level they might bump it to an outside adjusting and investigating company to handle. and so on and so on. Each level and dollar reserve level increases the experience of adjuster you will see or may see handling a claim. All this depends on the adjusters experience and training. So, normally when you first file a claim you get the adjuster who is just learning how to read the manual. You get to high dollars you get the ones who are in upper training and probably going to law school which is funded by the insurance company.

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