Now for the tricky part. Getting it wrong can cost you big time. In many states, claimants may assert that a delay in payment constitutes bad faith. Insurance companies and employers can be forced to pay stiff penalties for bad faith suspension, termination or failure to make payment. Denying a claim without credible evidence that it is “fairly debatable” is the definition of bad faith.
This is where an adjuster’s experience comes into play. To avoid making costly errors in claims handling practices, adjusters need to know what issues might be fairly debatable. In other words, it is crucial to know when state workers’ compensation law in allows employers to deny claims, and this is a moving target. Statutes are amended. Case law changes statutory interpretations. What might have created a fairly debatable issue a few years ago may no longer warrant a denial.
Compounding the problem is that worker’s compensation is a state statutory system. Everyone knows that work-related injures are compensable, but what makes an injury work-related is often subject to differing state laws. An occupational disease in one state may not be an occupational disease in another. The answer to the question of whether a worker is in the scope of his employment may be entirely different depending upon the state where he was working.
This is the difference between a general knowledge of worker’s compensation and state-specific knowledge. To successfully adjust claims, and avoid bad faith, you need state-specific knowledge. This is the kind of knowledge that comes through years of
experience or through trial and error.
A New Solution
The kind of state-specific training claimant attorneys inquire about simply did not exist. State administrative agencies generally do not offer certifications. Insurance companies themselves often lack any formal claim training program. National professional designations such as the Associate in Claims (AIC) offer no chapters on worker’s compensation laws in each state but instead offer guidance on general issues.
This is why the Wickstrom Insurance & Risk Training Center created a series of state-specific professional worker’s compensation professional designations. To achieve it, you must pass two courses. The first, entitled “How Workers’ Compensation Works,” provides a general overview of legal and insurance issues in worker’s compensation common to most states. Following this course, students move on to take a course specific to each state prepared by a local worker’s compensation attorney. By passing the corresponding exams, students earn a state workers’ compensation specialist designation.
Jean-Calvin
