A medical adjuster plays a major role in the handling of car insurance claims. The position may be seen as being in the background, but this adjuster is vital for ensuring good claims practice and legal compliance. Medical adjusters jump on board the claims process from the start of things. They review no-fault paperwork to ensure a claim for medical benefits can be properly processed. If they do not receive a no-fault application within a statutory time, they can reject a claim in its entirety. They may contact the claimant and take a brief statement of the injuries.
Adjusters require excellent organizational skills because the duties involve maintaining a file from inception to trial. This means compiling records from ambulances, emergency rooms, examining physicians, chiropractors and therapists. Aside from gathering these records, the adjuster is responsible for processing the bills for these medical providers. That means approving payment based upon state regulated deadlines. If a doctor submits a bill without providing adequate accompanying medical documentation, or submits a bill that contains incorrect codes, the adjuster catches these deficiencies. This is why adjusters need to be well versed in medical terminology, abbreviations coding practices and industry protocol. They must also appreciate patient confidentiality and should not provide copies of claimant records unless the request is properly made in writing with accompanying HIPAA authorizations. All these activities need to be done in compliance with the provisions of the insured's car insurance policy.
Another important role a medical adjuster plays is to make decisions about how long a patient's treatment should continue. Although the claimant may experience pain that shows no indication of abating, it doesn't mean the insurance carrier will permit treatment to last indefinitely. In general, the adjuster will diary treatment and arrange for an independent medical examination after the passage of a certain amount of time. The decision about when to arrange such an examination will be based upon the severity of the patient's injuries and the protocol used by the insurance carrier. Some carriers are more liberal than others in connection with allowing or denying the continuation of treatment.
Finally, depending on the insurance carrier that employs them, medical adjusters sometimes play the role of legal advocate. When they deny a medical claim, the response may be for the doctor or doctor's attorney to file suit to challenge the denial. Adjusters could be called upon to go to court to explain their actions. They can also be called upon to offer support to the insurance company attorney assigned to defend such a denial.
The medical adjuster position involves wearing several different "hats"in terms of multidisciplinary skills required and clearly has a great deal to do with car insurance.