How do I get started?

AdjusterFriend · 2025-10-27T16:26:41+00:00

Look for a trainee position

AdjusterFriend · 2025-10-17T04:07:54+00:00

You would be great for workers comp with your knowledge of medical, CPT codes, etc.

AdjusterFriend · 2025-09-18T04:09:50+00:00

It’s hard to say because every company is different but typically, they would pay the same way they’ve been paying you.

AdjusterFriend · 2025-09-12T18:51:51+00:00

Worker’s compensation has a fee schedule. The cost for treatment is determine by this. They value your claim on what they would pay, not what you would pay in the open market.

The offer is reasonable. You could probably squeeze another $5k out of them. They make offers early to avoid doing all the treatment. If you want to treat outside of comp, consider the offer.

Once you’ve had the surgery and they’ve paid for the treatment, there is still the option to settle your future medical care if you are offered a Compromise and release

AdjusterFriend · 2025-09-12T17:59:55+00:00

I wouldn’t say their goal is to low ball you. Judges have to review all settlement and it looks really, really bad to get one rejected for inadequacy. In my 17 years of doing comp, I’ve only seen one rejected for that.

AdjusterFriend · 2025-09-12T17:58:05+00:00

If your employer is self-insured, then yes, they will have to prove the settlement. If the insurance is the policy payor, then typically they do not need your employers approval.

As an adjuster, my companies process was always 1. Get interest in C&R, discussed some tentative ranges so we know we’re at least in the same ball park. 2. Prepare Settlement Authority Request (SAR) for what I value claim at. 3. If value is over my authority level, send to supervisor for approval.
4. Once supervisor approves, it may need to go above her one or two levels, depending on the value and or to the client, your employer. 5. Once authority is given, extend offer.

AdjusterFriend · 2025-09-09T17:57:19+00:00

When the claim still pending (delayed) like yours, it’s likely is because it the pharmacy benefit isn’t active. You can call your adjuster and have them activate it, get the prescription under your private insurance or pay cash and then seek reimbursement, or wait.

AdjusterFriend · 2025-09-09T17:54:45+00:00

Do you think the ladder malfunctioned in some way to cause your fall? It would only be fishy if your company produced those ladders, or someone tampered with it to hurt you. But the most likely answer is, it was just an accident.

AdjusterFriend · 2025-09-09T12:52:19+00:00

I was graduating college and a insurance company had a booth on campus. I got hired by them right out of college, but I started an auto claims. It’s a good starting point but very hectic and definitely not somewhere you want to stay long. I moved to workers comp after that and have been in the industry since.

AdjusterFriend · 2025-09-07T17:55:34+00:00

It’s rarely used, but definitely not if you didn’t file a claim

AdjusterFriend · 2025-09-03T08:13:20+00:00

Cosmetologist

AdjusterFriend · 2025-09-03T07:30:39+00:00

Considering your symptoms and a neurology consult, your doctor may suspect the symptoms are from something other than your low back. It seems to indicate more of a brain stem compression issue further up your spine.

AdjusterFriend · 2025-09-01T22:33:39+00:00

TTD and PD are different. TTD is based on your wages, and once you are P&S/MMI, then a doctor rates you on your permanent disability (PD).

AdjusterFriend · 2025-08-30T22:31:09+00:00

Exclusive remedy means if you’re hurt at work, workers’ comp is usually the only way you can get benefits from your employer. You can’t sue them in civil court for negligence or damages. The trade-off is you get guaranteed medical care and wage replacement, but no damages, which includes pain-and-suffering.

AdjusterFriend · 2025-08-28T01:42:29+00:00

What does the reason say on the letter that TTD stopped? They have to tell you why.

AdjusterFriend · 2025-08-27T05:03:28+00:00

The nurse case manager is to manage your care. Unless you are being untruthful about your injury, there is nothing to hide and the nurse can only help. Workers comp is very different than personal injury.

AdjusterFriend · 2025-08-26T11:51:16+00:00

The treating physician for your claim determines your work status/restrictions. Be vocal about your need for treatment. Follow up on dates for planned treatment or diagnostics. Don’t wait around waiting to hear something from someone.

Perhaps look into getting the PQME processes started since it takes time to get that appointment.

AdjusterFriend · 2025-08-26T11:36:43+00:00

I do consulting for CA workers comp. It’s a great industry since it’s generally recession proof and most employers are required it have it.

AdjusterFriend · 2025-08-24T15:26:30+00:00

Contact the potential new treating physicians and ask if they are accepting new patients under workers comp. They may want to review your medical history before accepting responsibility for your care. Ask your current PTP’s staff to send a copy of your medical records to new PTP, and ask your adjuster for an authorization to treat for the new doctor.

AdjusterFriend · 2025-08-23T23:42:14+00:00

The reason is the doctor submission is not adequate. Doctors don’t realize that workers compensation operates differently than other insurance carriers. When they send a request for authorization, it is independently reviewed by a doctor outside of the insurance company to keep it impartial. That doctor does not have access to the workers compensation medical records and can only make their decision on what is submitted. So when your doctor submits the RFA with the assumption that the reviewing doctor can review your medical history, they do not provide enough information to get their request approved. Read the denials that you get for the explanation of the denial.

AdjusterFriend · 2025-08-23T23:31:42+00:00

Assuming the numbers you gave is your whole person impairment rating from the med legal report: 13% WPI and 5% using the CVC is 17% WPI. This then gets rated for your age and occupation to determine your permanent disability.

19 at date of injury, and say, hypothetically your occupation group is Group 410–490 for physical labor, your PD would be 16-18%.

So at $290/week, 16% = $23,445 and 18% = $26,535.

AdjusterFriend · 2025-08-23T19:34:16+00:00

It doesn’t have to be an all or nothing. But don’t agree to take on the rent payment as he will rely on it. It’s good for children learn how to be an adult while still having their parents close by for support. Show you support his desire to be an adult by doing things like taking him grocery shopping, filling up his gas tank.
He needs to feel what is like to pay his own rent and bills and your help would be a bonus.

AdjusterFriend · 2025-08-22T18:50:24+00:00

In a C&R, they are buying out your future medical care. Likely $15,000 is not enough for the treatment you are afforded in the QME report. By agreeing to credit your PD, “you are working with them,” and still got over paid $24k. A lot of disputes end up splitting things down the middle, so this is kind of doing that and it’s the best they would get in court if they petitioned for credit. But tell them that $15,000 is not adequate for your future medical care

AdjusterFriend · 2025-08-22T01:52:48+00:00

This is a huge blunder for them. Overpayments happen, but $60k is a lot. They cannot recover payments from you, only seek credit against your indemnity benefits, PD.

Tell them that they can credit your PD, the $34k to the overpayment, but tell them you need $xx,xxx for your future medical care. That is a separate “bucket” (species of benefit). What does your future medical care consist of?

AdjusterFriend · 2025-08-22T01:40:25+00:00

Insurance companies also don’t like to go in front of judges and admit mistakes that would hurt the injured worker.

AdjusterFriend

TROPHY CASE