Well-trained claims adjusters can play a key role in evaluating valid work-related injuries while also protecting against fraud, says David Nowell, PhD, a clinical staff member at UMass Medical School and an expert in independent medical evaluations as a practicing neuropsychologist.
So much so, in fact, that claims adjusters can make more accurate judgements on the worthiness of a claim the physician attending the injured patient, Nowell says.
This can happen when a physician errs when completing forms for an insurance carrier related to a disability claim, according to Nowell, part of the Disability Evaluation Services team at UMass Medical School, which provides training to insurers, nonprofits and government agencies.
“Sometimes in a hurry or just trying to support the patient, they will indicate a number of restrictions and limitations that frankly, won’t be supported by the record,” Nowell says.
However, a well-trained insurance adjuster, with a broad background of clinical knowledge will be able to make an accurate and fair determination.
While the doctor won’t use terms like restrictions and limitations – which are industry jargon – claims adjuster with the right clinical knowledge can interpret the record and assess the evidence.
“An adjuster is able to look at that and determine if the restrictions and limitations identified by the treatment source are supported by the record,” Nowell says.