Adjuster Claim Capacity (Selecting a TPA)

One of the most important decisions a company makes is deciding who will handle workers' compensation insurance claims. Depending on your insurance arrangement, an in-house insurance company or a third-party administrator can handle your claims.

One of the key questions to ask prospective TPAs or include in your Request for Proposal (RFP) is about :

Adjuster Claim Capacity - That is how many claims will each insurance adjuster be handling? While this number ranges, a good rule of thumb is for each adjuster to have no more than 165 open lost time claims with less than 20 new claims each month. 

Best-in-class TPAs provide administrative support for adjusters allowing adjusters to focus on return to work strategy, communications with employer/employee/medical providers, and making judgments and decisions on the files. 

Adjuster administrative assistants perform tasks such as paying medical bills, sending requests for medical records, and filing and copying as needed. Lost-time case load for carriers and TPAs that do not provide assistance to adjusters, a lower case load will be necessary.

If there is any activity on a workers comp file, it should not be closed. A claim should be left opened in all the following situations. Read it.  

An employee usually will not opt out of coverage for a workers comp claim, but it does happen. There are also times when insurance coverage does not apply. When?

Only New York has an assessment of over 15% at a whopping 18%! Why? 

The #1 selling cost containment book for workers compensation is our 2012 Workers Compensation Management Program: Reduce Costs 20-50% manual. This 181-page guidebook helps assess company or clients' workers comp programs, design program materials, roll out a program to the organization, and monitor and manage the program once implemented.  

For 20 years, the National Workers' Compensation and Disability Conference & Expo has been the industry's leading training event. And this year's event is taking it to the next level - making it the best ever! November 7-9th 2012.