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Thread Title: I SUPPORT IT!
Created On Monday July 14, 2003 8:47 AM

pete.boggess@sfgov.org
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Monday July 14, 2003 8:47 AM

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I have been a workers' compensation claims examiner for 18 years. The Farmers judgment has certainly had a negative affect on my job. Whereas I could work whatever time was necessary to get my work done, that no longer happens since the companies will not authorize overtime. I had no problem with working more than 8 hours when necessary since I am a SALARIED employee, not an HOURLY, employee. The judgment had has certainly had a negative affect on the workers' compensation field but one positive is that it's forced the companies to look at individual case loads and adjust them so that there is more a possibility to get the work done in 8 hours.

I fully support the proposed Regulations.

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ORIGINAL ARTICLE:

Proposed Department of Labor regulations that were approved by the House of Representatives July 10 would exempt claims examiners from overtime pay and should aid insurers with further overtime clarification, according to the Alliance of American Insurers.

"The Alliance is encouraged by the House's action," said Kirk Hansen, director of claims for the Alliance, which sent comments to the Labor Department in support of the regulations. "Though the proposed regulations could still be stalled in the Senate, the House vote makes that possibility less likely."

The Department of Labor proposal is intended to clarify and simplify how employers determine who is exempt from overtime pay requirements under the Fair Labor Standards Act.

"The issue of whether insurance adjusters are due overtime pay has been the source of class action litigation, filed mostly in California," Hansen said. "By specifically mentioning claims adjusters, as an occupation that performs 'work of substantial importance,' and therefore exempt from overtime pay, the new regulations should help clear up any ambiguity in this area."

Farmers Insurance Exchange in July 2001was dealt a $90 million judgment in a class-action lawsuit on behalf of claims examiners on the claim that the carrier for years cheated them out of overtime pay.

The proposed regulations specifically mention claims adjusters and state that: Insurance claims adjusters also generally perform work of substantial importance, whether they work for an insurance company or other type of company, if their duties include activities such as interviewing insureds, witnesses and physicians; inspecting property damage; reviewing factual information to prepare damage estimates; evaluating and making recommendations regarding coverage of claim; determining liability and total value of a claim; negotiating settlements; and making recommendations regarding litigation.

The Republican-controlled House, by a vote of 213-210, blocked a Democratic initiative to prevent the proposed regulations. Fourteen Republicans, primarily from the Northeast, crossed party lines and voted with the Democrats on the vote.

Source: Alliance of American Insurers

jetilley@verizon.net
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Monday July 14, 2003 9:58 AM

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While I worked at Crawford & Company we were greatly UNDPERPAID and expected to work much more than the 40 hours our meager salary paid us for. I an sorry to see adjusters specifically singled out in this piece of legislation.

pete.boggess@sfgov.org
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Monday July 14, 2003 10:24 AM

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People who are underpaid do not have a valid reason to complain. They accepted the job at a specific rate of pay for x caseload. If circumstances change then they should either find another job or get out of the business if they continually think they are underpaid.

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counselor67@hotmail.com
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Monday July 14, 2003 10:54 AM

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I also agree with the propsed Regulations. As a Claims Examiner I have worked on both sides of the situation; as an underpaid, overworked examiner and as a fairly paid, reasonably worked employee (yes, companies do exist which pay you fairly and recognize the need to maintain reasonable caseloads). While the Farmers decision certainly helped open the insurance industries eyes to the need for reasonable caseloads, it has had a negative impact as well, in that when I truly NEED to stay late or come in on a weekend, I can't because I am not a salaried employee, and you CANNOT get overtime approved.
There are many times it's a simple matter of choice for me - I want to come in on a Saturday when there are no phones ringing and catch up on the diaries (creates a lot less stress when the diaries are current)- and there are times it is really a necessity. How do you walk out of the office when an employee has just been seriously injured, and you need to contact the hospital, er and ee's family for approvals and authorizations? To subject examiners to hourly employee rules & regs is just impossible. I've taken to working from home on those little extras that need to be done for the client, so I don't have to deal with the issue. Frankly, I think it creates MORE stress for an examiner knowing you have to get everything done in 8 hours, period, no exception. In our business, a one day delay could mean a large penalty! In a perfect world, we would all receive our F&A's & C&R's the day after they were issued, and noone would ever worry about being able to pay on time, but it's not a perfect world.

sharie
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Thursday June 02, 2005 8:49 AM

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Does anybody have any possitive info. as an adjuster? I am a claims asst. and I am going to start adjusting files real soon. It scares me to see so many unhappy adjusters. I need to hear possitive things to keep my head up. (smile) I am going to ask alot of questions in the near future, and I would really appreciate your expertise.

sfex
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Thursday June 02, 2005 6:00 PM

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As with any job, there is the good and the bad. Today was one of those days...

An unhappy injured worker complained to my supervisor about me. Sometimes no matter what you do, you won't be able to please everyone. So I wouldn't try. Just do your job.

But I also settled via C&R a case that's been ongoing since 2001. That was sweet.

So you have the good and the not-so-good, it's comes with the job.

tjfujii@scif.com
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Thursday June 02, 2005 8:06 PM

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I love claims. I stumbled into it long ago on my way to developing job skills for a job in a different dept, and liked claims so much I stuck around. Claims is where you can make a difference, you can be the person who sees the whole picture and acts with compassionate professionalism, treating IWs as you yourself would wish to be treated. Of course, there are great stresses and ridiculously short timeframes within which to perform some tasks, but really most jobs have a downside so you just deal with that as best you can. Having a good sense of humor and working in an environment where people work as a team and are supportive of each other is very important too - you can deal with external stressors much better when you aren't being upset unnecessarily by internal stressors. A spirit of friendly cooperation among co-workers and supervisors makes a huge difference. Heck, even if the supervisors are unfriendly (which I have never experienced thank goodness) it is good for your co-worker peers and assistants to huddle together for warmth, as it were.

And I have had experiences where I was empathetic and every time made the liberal compassionate more than necessary decision for an IW, and then after three years of that I would eventually have to say 'no' to something way over the top and they would turn on me in a heartbeat. That's disheartening and frankly very annoying. But a supervisor told me once that I should never allow the bad attitude or behavior of one IW influence in any way how I respond to the next one. Each person should have a clean slate going in, and no prejudgement on our part. Another supervisor also liked to say that we are administering a benefit delivery system, not a benefit denial system. We have to watch out for fraud when it occurs, and follow the laws on behalf of our policyholders, but that doesn't mean we try to limit benefits that are actually due or that we treat IWs unfairly. I've had some wonderful mentors over the years, and I try to pass that on to new adjusters as well.

Anyway, those are just some of my thoughts on adjusting. And if you do get into it and find that you really don't have what it takes to continue in it without wanting to do yourself some bodily injury, you can always take the skills and information learned in that job to move to the next one. No job you do, no matter how seemingly insignificant or aggravating, is wasted. It's all life experience stored up for the next step in your journey.

Wow, that's way too philosophical so at this point I'm just gonna stop. Good luck in your new position!

tjfujii@scif.com
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Thursday June 02, 2005 8:15 PM

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Oh, and I have to share this one with you because you said you were having a bad day because someone complained about you. Boy can I relate. A number of years ago we got a brand spanking new claims manager who didn't know me at all, and it was her very first day on the job in our office. A lien claimant called me up and became angry because I wouldn't settle a lien for almost full value (his position was nonsense, really it was). So the lien claimant called up and decided to make trouble for me with my manager, but he didn't want to give his name 'in fear of retaliation' he said. The switchboard refused to put the call through to the manager annonymously, so the caller told the nineteen year old operator that he was G Gordon Liddy. She, being young and not well educated, accepted that name without question and put him through. Imagine my shock when I was called into my new manager's office, my first meeting with her, and was told that G Gordon Liddy had called to complain about me!

sfex
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Friday June 03, 2005 8:09 PM

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LOL! I can understand the 19 yr old switchboard operator not knowing... but what was the claim manager's excuse?

I had one experience where the injured worker was so used to getting everything she asked for from the prior adjuster that when I came on to handle her claim, she was not prepared for someone who would dare say no to her.

Her request? She wanted her PD check sent to her by Federal Express - Next Day Delivery even though the check was not late and was scheduled to go out the next day. Her reasoning: she was behind on her bills and had to have the check the next day, so why not Fed-Ex it to her? When I said we weren't obligated to do that since her check wasn't late, she responded "well the prior adjuster did it." When I still refused, she went not to my supervisor, but to our Corporate office back East to complain to the top person in our claims operations.

I get a call from Corporate office, explained my side, and was told to go ahead with sending the check by Fed-Ex as the company did not want this EE complaining to the Dept of Insurance. I was new to the company and didn't know that's how they did things.

The injured worker calls me a week or two later, we talk for the first time (without yelling) for about an hour, I asked all the pertinent questions that I needed to handle her claim and moved on. A few hours later, I get a call from Corporate office saying the EE had called them again, this time to say that I was the first adjuster on her claim that asked her the relevant questions about her claim and that she was now satisfied with me as her adjuster.

We got along well after that because I set the tone for her to know what to expect - she hasn't asked for Fed-Ex'ed checks since.

tjfujii@scif.com
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Friday June 03, 2005 8:36 PM

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Well, my manager knew he was using an alias, she just wasn't sure what to expect from me yet, so the whole thing was presented very seriously for about five minutes and then it was just a funny moment to remember. Fortunately, she was a very good manager.

hrmsox
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Tuesday December 20, 2005 8:35 PM

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Ms. Fuji:

You are anything but a good adjuster. You work for the largest monopoly where it's almost impossible to get fired. Even if you don't perform. You don't even adjust files, just pass judgement. If you adjusted in the real world, I wonder if you could really hang. I don't think so. What keeps you there? It can't be the money because we know it pays poorly. Maybe it's all the free time you have trying to tell adjusters who are more qualified than you what to do. You have no clue.

Karma

andyourlittledogtoo
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Tuesday December 20, 2005 9:58 PM

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Wow. Did that make you feel all tingly and important to attack someone for no real reason? Get a grip.

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"For a long time it had seemed to me that life was about to begin, real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life." Alfred D'Souza

gaiassoul1@yahoo.com
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Wednesday December 21, 2005 9:22 AM

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I don't support it.

Prior to Farmers' way too many carriers paid no attention to caseloads, support staff and the like. IF you cannot get it done in a straight eight, your caseload and support staff need to be addressed.

Famers' was FORCED to adjust caseloads, support staff and the like to avoid paying overtime. Have you lost your mind in not getting full value for your talent?

Seriously.

stewshe@comcast.net
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Wednesday December 21, 2005 12:33 PM

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hrmsox,

I hate to have to admit it, but in the 24 years I've been on the applicant's side of the fence (prior to that I was a senior claims supervisor for "The Hartford"), I must say that SCIF adjusters, for the most part, I think honestly try to pay what they owe, no more, but no less either.

There are good and bad adjusters at all companies...with more than one! A company's reputation in claims is the sum of a person's experience with that company. I have worked on thousands of claims involving SCIF adjusters...possibly over 10,000. By and large they do a good job, IMHO, as does Zenith.

I realize there are some on this listserv who have had personal, nightmare experiences, with SCIF and with other carriers, so have I, for that matter. I've even had some bad problems with SCIF adjusters, but for the most part they do a better job than many of the other adjusters.

By the way, I mean "good" in the context of not necessarily agreeing with me all the time...sometimes I am "full of it!" I mean basically knowing what they are doing and doing a good, honest job. That is what an adjuster is supposed to do.

Hardly a week goes by I do not hear of an adjuster who (sometimes through an attorney who doesn't necessarily know any better either) says,

"We don't pay for mileage to a drug store...we don't owe it." [Hutchinson vs WCAB 17 CWCR 93, 54 CCC 124]

"We don't owe for meals. If someone travels from Fresno to Sacramento for an 11:30 a.m. appointment, we only owe 34 cents/mile, not lunch!" [L.C. 4600(e)]

"We don't have to send the applicant's attorney a copy of our UR denials." [12/13/04 T8CCR 9792.9(b)(3), since amended, but this section remains the same]

I could go on and on.

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Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

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James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

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Wednesday December 21, 2005 3:46 PM

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I disagree, Stew.

I have been involved in interpreter billing for many years, and my experience has been that SCIF adjusters are absolutely the worst, by far.

Their most common tactic is just to ignore your bills, but they also send you what I consider to be ridiculous objections with no basis in law or fact whatsoever. Of course, of all the numerous requests for medical reports and documents, they have yet to comply with even a single one.

wcadjuster@gmail.com
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Wednesday December 21, 2005 8:42 PM

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Does anybody have any possitive info. as an adjuster? I am a claims asst. and I am going to start adjusting files real soon. It scares me to see so many unhappy adjusters.

Sharie, you will learn very quickly that we are in a thankless industry. You will find a lot of unhappy adjusters, and you will find a lot of happy adjusters. It's what you make of it. Some adjusters definitely need to get out of the business, some shouldn't even be left out of the house.

You will have unhappy claimants, when you deny them a request. You will have unhappy clients, when you tell them what they dont want to hear. You will have unhappy, medical providers, attorneys, the list goes on. That is who generally calls to complain to your supervisor, your manager, anyone who is over you.

Rarely will you get one of those persons listed above who contacts those same people to compliment that you are doing a good job.

It's rare to work at places that have an actual trainee program. I know of a few, and know few adjusters that actually went through a training program.

My training went something like this.........."thats your desk, it has late diaries, that pile of mail is mail that needs immediate attention, and that pile is mail that needs response to within the next few days, dont forget to return the voice mail messages, oh and you might want to stay late to actually get to learn your 230 files"

Sink or swim, honestly I felt it was the best way to learn. I asked a lot of questions, and when I received an answer I questioned why. The mistakes I made I learned not to try and make them again.

Fast forward many years, I enjoy my job, make a very good living, and continue to further my knowledge. Also, just because you started with company "a" doesn't mean you have to work for them forever. You will learn that in this industry, sometimes you have to jump around to get the big "bumps" in pay.

Good luck Sharie, and remember to walk away from it, because it will be there tomorrow.

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