Missed Workers Compensation recovery opportunities

Workers’ Compensation Direct Action claims are definitely an area often missed by over-burdened workers’ compensation claim handlers working tirelessly to make sure statutory medical bills and indemnity payments are made timely, or argued in front of the WCB.  Workers’ Comp Adjusters are also challenged with time management relative to determining ANCR (Accident, Notice and Causal Relationship) to validate an injury is compensable.  Injury assessment, proper reserving and third party attorney inquiries take up the better part of the adjuster’s day leaving little time to even think about who or what caused the employee’s injuries.

It is less likely for a Workers’ Comp adjuster to ask if there was a “Mr. Somebody” who may have been responsible for those injuries, unless that adjuster was placed on notice by a third party attorney looking for copies of the medical and indemnity logs.  If approached the Work Comp adjuster will find the time to negotiate the lien and provide consent to settle but they are far less likely to aggressively pursue direct recovery from a responsible party, or institute legal action to do so.

How often are potential third party claims missed because there is not another set of eyes focused on pursuing recovery in a variety of ways?  Too many viable workers’ compensation claims are closed without pursuing the at-fault party directly. In addition to initially missing an opportunity to pursue recovery, the adjuster may have been alerted by the employee’s counsel they were pursuing a third party action when in fact they closed their file for any number of reasons and of course never notify the WC carrier.  Should the adjuster document their file that a Lien is viable, only to find out years later that litigation was never instituted, the statute has expired and there is no longer any recovery opportunity.

Work Comp Claims Managers must make a strong effort to educate their claims team on Workers’ Compensation recovery statutes governing the states where their employer policyholders conduct business to prevent the loss or pursuit of good recovery opportunities.