Insurance adjusters can face significant stress when weighing whether to endorse someone’s disability claim, as there is much at stake since it can be a potentially life-changing decision, says David Nowell, PhD, a clinical staff member at UMass Medical School and an expert in independent medical evaluations as a practicing neuropsychologist.
But proper training can both cut down on that stress and help adjusters make the most accurate assessments possible, notes Nowell, a member of UMass Medical School’s Disability Evaluation Services, which provides disability evaluation training to insurers, nonprofits and government agencies.
And while clinical knowledge is important, good training must go beyond simply memorizing facts to help insurance adjusters deal with the situations they will face in making disability assessments.
“Good training for claims adjusters makes it worth their time stepping away from their busy schedule,” says Nowell, who speaks and lectures on the complexities of disability evaluations. “It’s not just an overview; it’s not just an update on medical treatments.”
In assessing a disability claim, adjusters can find themselves in a situation where they feel they are on the spot, having to decide whether to believe a person’s claim to be seriously injured and unable to function in the workplace, or at least without modifications.
The stakes can be high, with the potential for fraud if the adjuster waives through a problematic claim and legal liability from an aggrieved individual if a valid claim is rejected.
Good training helps adjusters remove the personal element and look strictly at what the individual is reporting and whether that matches up with medical criteria. The session should also deal, in turn, with what criteria to look for, Nowell adds.
Overall, the content should be pitched to reach a wide audience, with some new adjusters coming from nursing or some other clinical background while others may be new to the field.
In addition, the veteran adjuster or professional leading the training should leave time at the end for a question and answer session, he says.
“With appropriate training for claims adjusters, we can have more uniformity across the process so that there is consistency and so that adjusters are looking at claims in a similar fashion,” Nowell says. “That is a safeguard against fraud, on one hand, and potential liability for the insurance carrier on the other.”