By Loretta Worters, Vice President, Media Relations, Triple-I
When Victoria Aumiller, AIC, WCP, claims specialist, Chesapeake Employers Insurance came to the organization 14 years ago, she didn’t realize how meaningful her job would be. Like many of her peers, Aumiller appreciates being able to make a direct impact to assist workers and their families.
“Being injured is painful for the worker and scary for the family,” she said, adding, “it’s very fulfilling to make the experience less frightening and to help the worker navigate the medical and claims process.”
National Workers’ Comp Adjuster Day, observed on August 17, commemorates the work of Aumiller and those who have made a significant impact on the quality of life of people with disabilities and their families.
“Their job is incredibly valuable,” said Sheila Fortson, WCP®, director – Corporate & ESG communications, National Council on Compensation Insurance (NCCI). “It’s a day of celebration, not only for workers comp. adjusters, but also for those who appreciate and respect their profession.”
Tess Madison, claims specialist with The MEMIC Group, said it’s the variety of people that she gets to work with and interact with daily that she enjoys best about being a workers compensation adjuster.
“We get to experience all spectrums of society and forge working relationships with injured workers, but also attorneys, medical providers, employers, and nurses. Working together for one common goal is a great aspect of the job.”
Workers compensation claims adjusters are licensed by the states in which they work. Their duties include analyzing often complex employee claims for compensation, reviewing documentation, and authorizing payments. When workers are injured at work or ill due to working conditions, they can apply for compensation for medical bills and lost time or the pay for missed work. Adjusters provide a detailed analysis of each open claim, including information related to the medical, disability, legal and financial aspects, as well as an action plan for claim resolution. When a serious injury occurs, claims adjusters are dedicated to helping injured workers get the medical care needed for a successful recovery while managing costs – a stressful and challenging role.
“When you make contact with the injured worker, it’s helpful to listen to how they describe the event and their injuries,” said Aumiller. “You can assess if there’s a layer of fear or trauma associated with their experience and how they are mentally handling the event,” she explained. “I determine what their current medical needs are from their symptoms and then coordinate the right medical providers to address their needs. I explain the process fully, answer any of their questions and explain what they can expect. The clarity of the process and answering those questions early on takes some of the fear out of the situation for them.”
After a work-related injury, an injured worker can feel a high level of stress, wondering how they are going to get the proper medical treatment and how they are going to support themselves and their families, noted Madison.
“Prompt response time and direction for medical care, along with communication throughout the process, can make a huge impact. Likewise, ongoing communication and updates with an employer make a difference, especially if they have limited staff and rely on a healthy workforce to keep their business running.”
Madison said being a workers comp adjuster is not only meaningful, but rewarding.
“A work-related injury is often an unexpected and difficult situation. Not a lot of people are well-versed in how the compensation system works and don’t know what to expect through the process,” she said. “Some people are living paycheck to paycheck. It is a great feeling to know that you are doing everything you can to facilitate recovery and return them to work, reassuring the injured worker throughout the process that we are here for them.”
Brooke Ray, a claims examiner with Encova Insurance, agreed.
“I communicate daily with claimants that are experiencing some of the most challenging days of their lives,” she said. “I’m fortunate I can play an active role in their recovery by facilitating timely medical treatment, offering support, and answering any questions that arise during their recovery. It’s very rewarding when a claimant acknowledges how much you care.”
“National Workers Comp Adjuster Day was created to mark the day for these unsung heroes who make important decisions that ultimately improve the quality of life of injured workers,” said Forston. “We observe this occasion to ensure they receive recognition for their commitment to the well-being of affected workers and their families. They are an amazing group of people.”