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| | Claims Adjuster Down, Shot, Code Three
By Jorge Alexandria - March 3, 2014
On Wednesday, Feb. 26, at about 5:30 a.m., a yet to be identified workers’ compensation claims examiner was shot at his home in the 9700 block of Grace Street in Bloomington, CA. The victim is an employee of the State Compensation Insurance Fund (SCIF). The shooter remains at large and police suspect the shooter could be a disgruntled claimant.
The adjuster is hospitalized and is expected to survive.
This led the California Highway Patrol to guard the offices of the SCIF on Day Street in Riverside, CA. SCIF is a quasi-state worker’s compensation insurance carrier. SCIF spokesperson Gina Simons said she had few details on the attack or who the shooter might have been. She said the agency requested the extra security. “Out of an abundance of caution we wanted to look out for the safety of everyone,” she said.
It may not break the top ten list of the most dangerous jobs in America, but the job of a claims adjuster is right up there and can prove risky. Think about it, claims adjusters are often in the front line and in the position of having to deny, deny and deny.
We deny benefits, deny treatment or from time to time cut-off someone’s badly needed check-- all of which could lead to a dangerous situation. Sometimes, even when it is apparent that the injury is legitimate, an adjuster may deny a claim at the insured’s instruction as the claimant’s employer feels as though they have been betrayed and will be taken advantage of when the employee files a claim.
California Highway Patrol officers guard the entrance to the State Compensation Insurance Fund office on Day Street in Riverside on Feb. 26, 2014. A workers' compensation adjuster employed there was shot in Bloomington in San Bernardino County earlier in the day.
There is a lot of emotion riding on a claim. Often time the examiner is the one who tells the claimant that his on the job injury did not happen as he described it and for good measure a recorded statement is needed. Or from the claimant’s perspective the examiner downplays the injury or the need for treatment and places a small value on the settlement. Worse still… after a long phone tree the claimant can’t get the adjusters on the phone or the adjuster doesn’t answer the phone and he won’t return the claimant’s call leading the claimant to show up at your place of business and placing the adjuster at risk to a physical assault. This is why several insurance carriers and third party administrators have removed their address on the letterhead and replaced it with a post office in Timbuktu.
Sarcasm aside, the dangers are very real. Take the case of two insurance adjusters Lawrence Biller, 38, and Bruce Horowitz, 46, who were shot and killed in New York a few years ago by a client who had made an appointment to see them. At some point in the conversation, the suspect just pulled out a 9-millimeter revolver and shot them dead. 11 shots were fired. Sure, the shooter was convicted but that is of little relief to the families of the victims a conviction won’t bring them back. So here are a few precautions you can take:
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Never let someone into your office without knowing who they are or verifying their credentials or identification card.
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Know who you are dealing with. Is the person an emotional dynamite stick? Trust your instinct, hunch or intuition as you get a chill down your spine for a reason.
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Insist that your company has security measures in place in case of an unannounced intruder or an active shooter situation. Have an exit strategy.
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Protect your personal information. Be careful of what you post online, on social media or Facebook, as a disgruntled claimant can capture your picture or your home address.
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If you are working late, have a friend or a night watchman walk you to your car and have your keys readily accessible to open your car.
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Learn self-defense strategies: not to fight but to escape in the event that someone has you on a body hold.
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Above all, treat everyone, including a claimant, with dignity and respect just as you would like to be treated.
Jorge Alexandría is a U.S. Army veteran who received his B.A. in Political Science from Cal State Los Angeles, and graduated from Cal Poly Pomona with a Master’s Degree in Public Administration.
He holds both a California Workers Compensation Claims Professional (WCCP) designation and the State of California’s Self-Insured Administrator’s License. He has more than 20 years of experience in claims handling, supervision, and risk management.
He currently practices federal workers’ compensation of maritime interest.
He can be reached at Riskletter@mail.com. The views and knowledge expressed in this article are Jorge Alexandría’s alone.
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