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Challenge
A Client had multiple Workers’ Compensation claims assigned by its insurance carrier to the same adjuster, who had a history of reserving
her claims at the maximum amount.
One of the Client’s injured employees sustained a leg fracture, but returned to full-duty employment within one month of the accident. Despite this,
the adjuster still had an indemnity reserve of $18,000 and medical reserve of $5,000 more
than 3 months later.
Another of the Client’s injured employees fractured his shoulder in a slip and fall accident. Anticipating surgery, the same adjuster set high reserves.
Action
On the first claim, our Occupational Nurse
Consultant recommended the adjuster to perform
a thorough review of the indemnity reserve and
the medical reserve. On the second claim, our
Occupational Nurse Consultant requested an
Independent
Medical Evaluation be performed.
Results
On the first claim, the adjuster reduced the
indemnity reserve to $0 and the medical reserve
to $2,500. The claim closed within
four months.
On the second claim, the
results from the IME
concluded surgery was not required. The medical reserves were reduced over $12,000. |