Clinical knowledge a must for insurance adjusters reviewing disability claims

November 21, 2017

Disability claims can be tricky, especially when it comes to concussions and brain injuries, and insurance adjusters often have to make difficult calls. Having the right clinical knowledge is crucial.

“It is important for insurance adjusters to have a basic understanding of a broad range of disorders in multiple systems,” notes David Nowell, PhD, a member of UMass Medical School’s Disability Evaluation Services and an expert in independent medical evaluations as a practicing neuropsychologist.

There has been a dramatic increase in disability claims filed with Social Security over the last few years, with private insurers also seeing an increase as well.

UMass Medical School’s Disability Evaluation Services handles more than 40,000 disability evaluations a year. They assist state and local government agencies as well as retirement organizations in Massachusetts, New Hampshire and Missouri. The team also provides disability evaluation training to insurers, nonprofits and government agencies.

Armed with a broad clinical training and background, insurance adjusters, as well as registered nurses, certified vocational workers and other clinical staff, can confidently conduct disability evaluation exams, he says.

Well trained professionals know to look at the patient’s symptoms and determine whether it matches “known injuries” and if the injury in question can account for the issues the patient is reporting.

“If they have a basic understanding of these conditions, then they are able to compare known presentations of dysfunction to what the claimant is describing,” says Nowell, who frequently speaks and conducts workshops on the complexities of disability evaluations.

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