A workers’ compensation claim is usually filed for coverage of medical-related services received as a result of a work
related injury. It is the responsibility of a workers’ compensation claims adjuster to receive and organize all
documents related to the employee and the injury in order to make a determination regarding the claim.
The worker’s compensation claims adjuster is responsible for handling workers’ compensation claims and
files. Once the claim is filed for an injured worker, the adjuster is responsible for determining whether the
worker was injured at work and whether the claim is compensable. If the claim is accepted, the adjuster
helps coordinate care for the injured worker by approving and authorizing treatment, surgery, medications
and appointments. The adjuster pays the bills on the file, which include wages to the injured worker for time
he is unable to work, payment to doctors and pharmacies, payments to attorneys for consulting and giving
legal advice on the file and any other payments that may occur within the scope of the claim. The adjuster
sends out legal notices as required by the state to inform the injured worker of his rights and anything he
may or may not be entitled to. The worker’s compensation claims adjuster works with the employer and the
employee to get the injured worker well and back to work, even if it’s in a light or modified position.
The worker’s compensation claims adjuster will be working in a cubicle, generally sitting the entire work shift
at a desk behind a computer.
Who They Work With
A worker’s compensation claims adjuster works hand in hand with a large number of people to treat an
injured worker and get her back to work. A worker’s compensation claims adjuster works with nurses and
doctors to help coordinate patient care and authorize treatment. They work with medical billers to ensure
bills are paid and services are billed correctly. A worker’s compensation adjuster works with employers and
employees. Depending on how complex the file becomes, an adjuster may also work with both defense and
plaintiff attorneys and paralegals. In some states, if the employee is unable to go back to her position due to
injury, training for a new position is required, and a claims adjuster is required to work with a vocational
counselor or schools to get the injured worker back to work.
High school degree or the equivalent.
5-7 years experience adjusting WC claims.
Has to be bi-lingual
Excellent communication skills