- Ensuring that a claim satisfies legal and technical requirements.
- Mediating between the injured employee, the employer, and the insurer to resolve disagreements.
- Assisting the employer and employee to find solutions in the event that workers’ compensation won’t cover an injury.
A workers’ compensation claims advocate is a professional who specializes in helping employers manage their relationships with their workers’ comp insurance providers. Their most important role is to help the employer manage claims. For many employers, developing in-house expertise on claims processing is difficult or impractical, so they hire outside firms, often an insurance brokerage, to provide claims advocacy services. For the injured worker, a claims advocate can be a good resource and a significant help in the event that a claim is denied. At the same time, however, the employee needs to understand that the claims advocate’s job is to represent the employer, not the employee. A claims advocate works with his or her clients to help them manage the costs of their workers’ compensation program. The idea behind the role is to help employers avoid expensive litigation arising from denied or mishandled insurance claims. An advocate may provide a wide range of services, from training employees on risk management to helping resolve conflicts with insurers. A claims advocate typically has an insider’s perspective on how insurers operate, and can sometimes resolve issues in a way that avoids more costly forms of intervention. Employers often work with claims advocates as part of a broader investment in the welfare of their employees. As such, a claims advocate’s role is partly to help ensure that an injured employee gets the coverage they need. Employees can benefit from an advocate’s assistance in a number of distinct ways: