Workers' compensation relies on, and adds complexity to the U.S. health care system, which is already one of the most complicated and inefficient in the industrialized world.(Photo: Shutterstock)
Workers' compensation is a complicated and litigious market. Many of the headlines we see revolve around settlements paid out in court. Some believe litigation is the consequence of injured workers who collaborate with attorneys to take advantage of the system, but data paints a different picture.
4 system failures that lead to litigation
Adjusters are overloaded - Most experts agree a single adjuster should manage no more than 120 cases simultaneously, but according to a 2016 Claims Salary Survey many manage over 150 cases. And not all claims (or adjusters) are created equal. Lost-wage claims take longer to process and require more effort than medical-only claims. However, many claim management organizations do not factor the varying degrees of complexity or time engagement when adjusting caseloads.
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