Insurance Career Spotlight – Workers’ Comp Claims Examiner
There are times when people are injured during the course of doing their job. When this happens, the usual procedure is for a workers’ compensation claim to be filed. The purpose of the claim is to apply for coverage of medical costs that may be incurred as a result of the injury.
Workers’ compensation claims examiners check to see that those submitting applications are following the proper procedures. Examiners review the claim and based on what they find, decide if an employee should receive compensation, and if they do, how much should be paid out. Examiners usually work for health or life insurance companies
The examiner is responsible for handling all documents connected to the employee and their injury, so a decision can be made about the claim. When making such decisions, the examiners follow company guidelines. The exact duties and responsibilities of an examiner will differ depending on the company.
The Process
If a person is injured on the job, they first see a physician. The human resources department generally notifies the examiner of the situation. The examiner then contacts the employee to get information about the circumstances relating to the incident. The examiner also contacts the medical professionals who examined the patient to get their records as well. After gathering all relevant documents – medical records, employee statement, employer forms – the examiner evaluates all the information to determine if the injury is work related or not. If the examiner decides the injury is not work related, they notify all the concerned parties – employee, employer, medical personnel. The process then ends here, unless the employee appeals the decision.
Work-Related Injuries
If the examiner decides the injury is work related and meets all other claims’ criteria, they open a file for the employee. All subsequent medical claims are sent to the examiner, who reviews them and forwards them for payment. He is informed of the employee’s progress, the status of the injury and the treatment.
The file is closed when the employee no longer requires medical attention.
Salary
The average salary for examiners is about $60,000 a year.
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