Claims Adjuster

Workers' comp claim examiners communicate with workers' compensation claimants, employers and other relevant parties while investigating employees' work compensation claims. Claims adjusters have the authority to determine whether an injured worker should be awarded workers' compensation and how much they should receive for their work injuries.

Other common terms for this position include a work comp examiner or administrator. The claims adjuster is employed by the worker's employer, the employer's workers compensation insurance company, private claims adjusting companies, and insurance brokerages. They also may be self-employed.

The claims adjuster does not advocate for the injured employer, and it is not uncommon to have disagreements with the claims adjuster. For instance, the claims adjuster may disagree with the amount of compensation owed to the worker or deny a workers' compensation case.

Main tasks for the claims adjuster

The primary task of the claims adjuster is to review work comp claims. Adjusters also work closely with the medical claim examiners and adjusters to ensure the proper remuneration for all medical costs, including those for doctor bills, crutches, surgery, physical therapy, rehabilitation, etc.

If a worker's injuries result in a permanent or temporary disability the claims adjuster will determine whether the claimant will qualify for permanent total disability, temporary total disability, permanent impairment, or temporary partial impairment. This determination is made after the claims adjuster identifies a specific rating for the worker's impairments.

Becoming a claims adjuster

There is no formal education required to be a workers' compensation examiner, but most examiners have an associate or bachelor's degree. Adjusters also generally obtain voluntary certification, have experience in a legal field, such as paralegal or law enforcement work, and they must pass a certification examination.