What is the role of the workers' compensation adjuster?

The role of the workers' compensation adjuster is fundamentally centered around managing claims and facilitating communication between all parties involved in a workers' compensation case. This includes the injured worker, the employer, medical providers, and legal representatives if necessary. The adjuster is responsible for ensuring that the claims process runs smoothly, overseeing the investigation of claims, and making determinations regarding the validity of claims based on the evidence gathered.

The adjuster also plays a critical role in coordinating the necessary benefits for injured workers, such as medical treatment, wage loss compensation, and rehabilitation services. This requires effective communication skills to address any inquiries or concerns from workers and to liaise with employers and medical professionals to support the injured employee’s recovery and return to work.

While denying claims that are not legitimate falls under the responsibilities of the adjuster, it is only one aspect of their broader role. The adjuster's primary focus is not solely on denying claims but rather on facilitating a comprehensive resolution to claims in a fair and timely manner. They do not represent injured workers in legal proceedings, as that falls within the purview of legal professionals, nor do they determine healthcare treatment options, which is the responsibility of healthcare providers.