Quarterback: The Accident Benefit Adjuster

Leadership is definitely one of the most important skill an accident benefit adjuster needs to effectively manage a motor vehicle accident file. Sometimes the adjuster can feel like a quarterback with everyone depending on his/her vision and ability to efficiently follow through on a proactive plan, while effectively communicating each “play” or progress with all team mates — in this case, the rehabilitation team and other stakeholders.

Much like a football team, the rehabilitation team and other stakeholders, including client, family members, employers, legal counsel, hospitals and all treating specialists and healthcare providers, look to the adjuster for direction.

Like the quarterback, adjusters must not only have a ‘big picture’ strategy, they must also be tactical, with the ability to quickly and expertly adjust the strategy as the rehabilitation plan unfolds.

Like the quarterback, the adjuster must also be motivational, creating a sense of teamwork as everyone works toward the common goal — creating a winning situation for the client of a timely return to maximum recovery.

Kickoff

Laying the foundation by way of a comprehensive and proactive rehabilitation plan is the most effective way for adjusters to set up the file to facilitate client recovery. Similar to the quarterback whose best approach is to be offensive rather than defensive, adjusters who set the scene by being highly proactive create a win-win for everyone involved in the file. The best way for adjusters to ‘set the ball in motion’ is to ensure they have initiated all aspects of case management:

• Co-ordinate and share information with all stakeholders on a continuous basis throughout file duration (i. e. client, family members, employers, legal counsel, hospitals and all treating specialists and healthcare providers)

• Obtain medical records from treating professionals

• Co-ordinate all assessments to ensure all client issues are addressed (e. g. occupational

• Therapy, in-home assessments, attendant care aassessments, physiotherapy assessments, job site assessments, etc.

• Refer for insurer examinations as appropriate and follow-up on recommendations

• Facilitate discharge planning

• Co-ordinate return to work plan– everything from arranging for a functional abilities evaluation, to ensuring medical clearance, to participate in the RTW plan, to negotiating plan with the client and employer and facilitating the plan’s execution.

• Monitor progress throughout the entire file duration with a special emphasis on communication to all stakeholders to avoid overlap and/ duplication of services and a proactive approach to rehabilitation that will result in time and cost efficiency.

Consider using the checklist to keep track of the range of medical reports and records that need to be obtained.

Medical reports/records

Pre-MVA records

• Canada Pension Plan records

• Co-insurer records

• Physician records (e. g., general practitioners, other treating specialists, psychiatrist, psychologist, etc.)

• OHIP records

• School records

• WSIB records

• Veteran Affairs Canada records

Post MVA records

• Ambulance report

• Emergency room report

• Hospital records (e. g., records may need to be requested from more than one hospital)

• Rehabilitation facility records It is particularly crucial the

adjuster expertly quarterback the discharge planning process. A proactive discharge can ‘get the ball rolling’ in the right direction and pave the way for a smooth transition from hospital to home.

Conversely, a rush discharge often places a lot of undue stress on the client and family or worse, the result can be discharge to an environment that is not ideal for maximizing client recovery. The client’s progress is often impeded by a last minute approach to the discharge planning process.

The proactive adjuster takes the lead:

• Contact hospital discharge planner/ social worker

• Ensure all recommendations of hospital occupational therapist have been implemented and assistive devices rented/purchased and delivered prior to discharge • Arrange for transportation if required

• Refer for in-home occupational therapy assessment and attendant care assessment (as required)

• Arrange for attendant care (family or agency) prior to the in-home assessment and convalescent care as needed

Knowing your bench strength

A key principle of effective leadership critical for the quarterback is the ability to accurately assess each team member’s strengths and special talents. An effective leader then supports and inspires each team member to bring these special abilities to the forefront. For the adjuster this starts with getting to know the client.

An in-depth understanding of the client’s post-accident issues, as well as pre-accident lifestyle is imperative to building the best team to support the client and facilitate maximum recovery:

• Obtain medical history from treating physicians (current & past clinical notes/records)

• Find out if there is a co-insurer

• Determine educational and vocational history

• Determine current employer and vocation

• Develop an understating of activities of daily living pre-and post-accident, as well as leisure activities (e. g., hobbies, other interests and skills)

• Assess the rehabilitation potential barriers to rehabilitation, for example:

• prior medical conditions

• nature of injury/disability

• availability of physician(s) or rehabilitation history

• transportation issues

Based on a thorough understanding of the client’s situation, the adjuster can then pull together the rehabilitation team with the best skills to match the client’s particular needs.

Using well-honed leadership skills, the adjuster assesses each team member’s unique strengths and their ‘fit’ with the needs of the file. As a result, the client feels that their needs are being appropriately addressed and the adjuster has accomplished this in the most effective and efficient way possible.

Avoiding a fumble

‘Dropping the ball’ by letting important details fall through the cracks can cause the entire rehabilitation plan to lose momentum or even grind to a halt until the various team members can get back up to speed. The best way to avoid this situation is to be focused on facilitating continuous communication with and between all team members. This is especially critical when creating the rehabilitation plan and assembling the best team however, it continues to be a critical success factor throughout the duration of the file.

Overall, as the quarterback, the adjuster is the client’s hero; the client depends on the adjuster’s leadership skills to be superior with an emphasis on proactive and continuous communication.

Angela Veri is national director of customer relations at Sibley Inc.