The adjuster employed by the third-party administrator (TPA) is the person who controls most of what happens on your claim. Many injured workers mistakenly think that it is the employer that makes claims decisions. While the employer may have considerable influence with the claims adjuster, the adjuster may also make decisions your employer does not like. You therefore need to know the name of your adjuster, his or her phone number, and ideally, their email address. The clinic where you initially obtained medical care should be able to tell you the name and phone number of the adjuster if you cannot get that information from your employer before you get a letter from the adjuster either accepting or denying your claim.
Try to communicate with your adjuster in a way that provides you with a record of the communication so that you can file an appeal if the adjuster fails to act on your request within 30 days. Keep a copy of any letter that you send, and print any emails. Make a note of the date and time of phone conversations. Be sure to have your claim number ready when calling the adjuster, and put the claim number of all written or electronic communications.
Make it easy for the claims adjuster to agree to whatever it is that you are requesting. For example, if you are requesting a benefit check, make sure that you have provided the adjuster with a copy of the physician progress report that takes you off work, or that gives you work restrictions that your employer cannot accommodate. Or, if you are requesting a consultation with another physician, obtain the last report from your current physician, as the adjuster will want to review that before acting on your request to see a different doctor.
Be pleasant when speaking with the adjuster, and give the adjuster a reasonable period of time to act on your requests. Ask the adjuster when you can expect an answer, and do not call repeatedly or daily. Most adjusters are reasonable and try to do the right thing. Most also have too many files to handle properly. Think of ways you can make the adjuster’s job a bit easier so that your requests are acted on quickly.
