California Workers Compensation Insurance: Caseload Catastrophes

california-workers-compensation-insuranceIn this fast-paced world, we’re all multitaskers. Juggling multiple responsibilities is a requirement for survival these days. But each of us is guilty of occasionally biting off more than we can chew. And what happens when we do? One or more items on the “to-do” list inevitably slip through the cracks.

There’s nothing wrong with that if you’re talking about replacing the light fixture on your back porch that hasn’t worked in three years. But if that’s how your third-party administrator (TPA) workers’ comp examiners are handling your employee injury claims, it’s probably costing you a lot of money unnecessarily.

In fact, your claims examiners’ workloads could be one of the key variables impacting your overall workers’ compensation costs.

But when does effective multitasking become ineffective overload? Claims professionals have been struggling with that question for years as they try to define the “ideal” caseload. Bottom line – there is no one-size-fits-all definition. The ideal caseload for one examiner may not be ideal for another, and it depends on several factors, including:

  • The nature and complexity of the case
  • The examiner’s experience and efficiency level
  • Technology available to the adjuster
  • The expectations and support of management
  • Time needed to resolve each claim

What happens when your workers’ comp examiner is overloaded?

Mistakes happen. Deadlines are missed. Stress and blood pressure levels go up. Disputes and litigation increase. And claim costs can go through the roof. Here are just a few of the potential profit-eating consequences of having an adjuster with a caseload that exceeds his or her capacity, experience, or training:

  • Failure to establish a good working relationship with the injured worker
  • Missed diary dates and failure to follow through on plans of action
  • Poor reserving practices
  • Overpayment of benefits and medical bills
  • Missed clues about exaggerated or fraudulent claims, excessive treatment, or prolonged disability
  • Missed opportunities for subrogation
  • Poor documentation
  • Missed filing deadlines that will incur fines and penalties
  • Triggering bad faith lawsuits by failing to conduct competent investigations, failing to respond to settlement offers, ignoring communications from policyholders or claimants, or hurriedly issuing specious claim and coverage denials
  • And the list goes on …

How do you make sure your examiners’ caseloads aren’t too large to offer you efficient service?

You can ask, though some third-party administrators (TPAs) will be reluctant to share that information with you. You can try to review the nature and type of claims the adjuster is handling, and review the requirements of your state’s workers’ compensation laws. As a last resort, you can hire an independent claims auditor to complete a Best Practices Audit of your TPA’s files. The auditor can help you identify the specific issues impacting claims handling and the appropriate caseload for each adjuster handling your claims.

A better solution

If you want an easier way to make sure your claims get the attention they deserve, just call Republic Capital Claims Administrators. Our highly experienced adjusters maintain caseloads of no more than 135 claims, assuring efficient handling of your files. That’s money in the bank for you. Contact us today to learn more.