How do workers’ compensation adjusters evaluate a case

The workers’ compensation evaluation process ensures fair and just outcomes for both employees and employers.

Adjusters assess cases to determine the extent of benefits an injured worker may receive.

Initial report analysis

The average workers’ compensation cost in the 2020-2021 fiscal year was $41,757 according to the National Safety Council. However, the recipients had to undergo a process that began with an analysis of their injury report. This document provides important information about the incident, including the nature of the injury and how and when it occurred. Adjusters review the employee’s job description, witnesses and the location of the incident.

Medical documentation scrutiny

Adjusters look over medical reports, diagnostic tests and treatment plans. They search for a clear connection between the injury and the workplace incident. They also review the severity of the injury and its impact on the employee’s ability to work.

Verification of employment details

Adjusters verify the worker’s employment details. They confirm the individual’s job responsibilities, work hours and employment status at the time of the incident. This helps determine the employee’s eligibility for compensation benefits.

Witness statements and interviews

Adjusters often seek statements from incident witnesses. These statements reveal the circumstances surrounding the injury. Adjusters may interview the injured worker to gather more details about the event and assess the consistency of the information provided.

Continuous communication with healthcare providers

Adjusters may seek clarification on medical reports, inquire about the progress of the employee’s recovery and gather information on anticipated future medical needs. This collaboration helps adjusters understand the case.

Workers’ compensation evaluations are meticulous. They can take months to complete, and those who submit claims should exercise patience and understanding during the process.