A DEGREE IN APPAREL MERCHANDISING LED HER TO A CAREER IN WORKERS’ COMPENSATION:  Karyl originally wanted to be a fashion buyer and move to NYC after graduation from Indiana University. She changed her mind about moving and wanted to stay in the Midwest. There aren’t a lot of fashion-buying careers in Indiana, so Karyl tried a Retail Management internship. She quickly realized that a career in Retail Management was not suited for her, so she attended a job fair looking for a new opportunity. An insurance company recruited her at that job fair. She didn’t know what Workers’ Compensation Insurance was, but she thought it sounded interesting and would try it. Her career has been going strong for almost twenty years.

THERE IS NEVER A DULL DAY WORKING AS A SENIOR CATASTROPHIC RESOLUTION SPECIALIST:   Berkley Industrial Comp specializes in High Hazard Workers’ Compensation Insurance, which means we do not usually have high-frequency claims or small claims. When injuries occur, they are generally challenging or severe due to the types of businesses we insure. The majority of the claims that Karyl handles are either Catastrophic Claims (CAT) or complicated legal claims. There is a wide variety of claims, such as injuries from industrial tools, mining, falls from great heights, motor vehicle accidents, and chemical inhalation. 

THE CLAIMS INVESTIGATION IS ONE OF THE MOST CRITICAL COMPONENTS OF A CLAIM:  The claims investigation involves taking statements from the employer, the injured worker’s direct supervisor, the injured worker (via recorded statement), witnesses to the injury, and the person who initially reported the claim. The adjuster needs to obtain any photos, dashcams, closed circuit TV videos, and black boxes from vehicles to assist in their investigation. Another great source of information is our Risk Management Team because they can help explain the injured worker’s job duties, the type of equipment involved in the injury and help the adjuster understand the job industry. The investigation will determine if the claim is “compensable,” defined as within the “course and scope of the injured worker’s employment.” The simplest explanation of compensability is to determine if the injured worker was working at the time of injury and was the injury work-related. It is important to obtain all of the information, such as what the injured working was doing at the time of injury, is there a safety issue that caused the injury, was there intoxication at the time of injury, and to confirm if anything malfunctioned. Another great resource is defense counsel because every state has different rules concerning compensability. While some states find that a safety violation does not affect compensability, other states may have statutes that can deny compensability based on a violation. A thorough investigation can reveal if proper safety equipment is needed or if additional safety training needs to be conducted to prevent future injuries.  

WHAT IS THE FIRST STEP IN THE INVESTIGATION JOURNEY? It is important to thoroughly review the First Report of Injury (FROI), which is the form that reports the claim to the carrier. It summarizes what happened, who reported the claim, witnesses to the injury, and where they sought initial treatment. It also gives an idea of where the employer is located and where the injured worker lives. This is very important information because there are times when an injured worker works in one state but lives in another. If an injured worker lives in Ohio but is injured in Texas, they will likely have to return to Ohio for recovery and treatment. It will be crucial to find out the exact state jurisdiction of that claim so the correct state’s statutes are complied with during the handling of the claim. When an adjuster reviews the FROI, they will need to confirm the information presented on the form. Do not rely solely on what is written on the form because the information may not display the seriousness of the injury. For example, suppose a claim is reported as a head laceration. In that case, this will need to be verified with the medical provider because the head laceration could actually be a traumatic brain injury.

RECORDED STATEMENTS ARE CRUCIAL: As time passes, witnesses may change jobs, attorneys may become involved, and memories can fade. If an adjuster has a recorded statement, they have memorialized a conversation. The adjuster can refer back to it later if their notes do not reflect something specific that was discussed. The statement may also be needed later in the claim if there is litigation and the injured worker makes statements contradictory to what was said in the recording.

WHAT QUESTIONS SHOULD BE ASKED DURING THE RECORDED STATEMENT? When taking an injured worker’s recorded statement, it is very important to ask how the injury occurred, what they were doing at the time of the injury, and what specific body parts were involved. The adjuster should ask specific questions to understand the full extent of the injuries. It is important to understand the circumstances around the injury. For example, if an injured worker was on medication that they should not have taken at the time of injury, this could possibly be a drug violation.

BE EMPATHETIC: When you ask the injured worker questions, do not “drill them”; instead, listen to what they have to say. Do not be judgmental or make assumptions. Make sure you ask follow-up questions to clarify the information. “If we don’t ask, then we don’t know. “This is the adjuster’s chance to not only investigate the claim, but to explain the workers’ compensation process, and build a relationship with the injured worker. It is important to remember that when you speak with an injured worker, they are hurt, scared, and worried about how they will provide for their family. The goal is to do the right thing for everyone involved. It can be a balancing act because there is a policyholder who is paying a premium and an injured worker who is injured. We have to conduct a thorough investigation to ensure all of the facts line up and determine whether or not the claim is compensable. Regardless of whether the claim is compensable, be empathetic, and treat others like you would like to be treated.