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Career Story: Compensation Specialist For A Workman's Comp Insurer

Compensation Specialist For A Workman's Comp Insurer

Job Title: Compensation Specialist

Type of Company: My company provides workers' compensation insurance as well as employment law insurance to employers.

Education: Certificate, Paralegal Studies, New Jersey School for Paralegals. I also have my SCLA and I'm working on my AIC.

Previous Experience: After graduating, I took a job at a law firm where I worked for four years. I then accepted a position as an insurance company claims adjuster, doing third party work. Three and a half years later, the company I was adjusting for hired me as a resident compensation specialist and I have been with them in that capacity for 12 years.

Job Tasks: When an employee gets injured on the job, his employer files a report with our company, which I then proceed to investigate. First, though, I have to ensure that his policy is up-to-date. But once the investigation is truly under way, I telephone the employer and take a statement from a representative and interview witnesses. Then I call the injured worker and take a recorded statement from him. If the injury is catastrophic, I will go to the site and take pictures. Next I contact the doctors who've been treating the victim to check on causation and work capacity.

With all the investigative materials in order, it's time to make a decision. Do we pay or deny? If we pay, the process continues with the filing of appropriate forms and the disbursement of payments for lost time, specific loss and medical benefits. If the claim is denied, on the other hand, we file a "Notice of Controversy." The employee has the right to contest such a denial. If he does, we try to arrive at a compromise agreement, one that neither party's happy with but one in which we both give a little bit of ground. If mediation fails, and it sometimes does, we then go into litigation and I arrange a referral to an attorney, working with him (or her) on the discovery portion of the claim. We may come to a lump sum settlement agreement and this can require my attendance at a hearing for approval. We may also need some surveillance or a second opinion. But our principal objective is to bring the case to a swift resolution.

Best and Worst Parts of the Job: The worst part of my work is all the deadlines and the compliance forms. Maine's law is very scrupulous and its expectations are at times impossible and most definitely exhausting.

The best part is helping someone out who's in need and putting them at ease. It's bad enough that employees get injured, but if we can do our part to keep them from having to worry about money, it's very rewarding.

Job Tips: This is not a nine-to-five job. You need to expect to work long, hard hours every day and sometimes on the weekends. The work is endless and there are many times when you are needed, it seems, round the clock. You need to be able to multi-task too. Furthermore, you should not be a person who gets easily riled. These injured workers are in pain and are not always pleasant to deal with.

Additional Thoughts: The most important personal qualities to possess to do this job? You need to be patient yet aggressive, forceful but compassionate, and you need to pay attention to detail.

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