For applicant attorneys

How to Get an Adjuster to Act on Your Demand

Jessie Zaylía, Esq. · Certified Specialist, Workers' Compensation

You send the demand. Then nothing. Six weeks later, the file is still sitting there and you're deciding whether a follow-up call makes you look anxious.

Of course, the adjuster has to get authority. Everyone knows that part. What gets less attention is what asking for authority costs the person who has to ask.

What the demand has to survive

An adjuster does not just need permission. They need the settlement to look like good claims handling when it comes up in file review. Their supervisor is watching two things at once: (1) are files closing, and (2) is money leaving carefully?

Paying your number has to read as disciplined and as saving the carrier money. If it reads as rolling over, the adjuster wears that, not you. And, simply put, they're not going to put their neck on the line. So, instead, if you can make them look like a hero while settling higher for your client, that's a win-win for everyone.

Running alongside it is the reserve. If they set $45,000 two years ago and now need $180,000, that swing is its own conversation, and it is not a pleasant one. Late reserve movement looks like something got missed. Nobody wants that memo with their name on it.

When it can't do that job, they have to build the justification themselves out of a sixty page AME report, which is a two hour project by hand on a file that isn't due yet. And even if they use Copilot, it often isn't worth the energy of context switching if they aren't taking your demand seriously to begin with.

So, back in the stack your demand letter goes, and nobody calls to tell you why.

None of that means your demand has to be softer. It means it has to be liftable.

The four pieces that get lifted

An evaluation letter and a reserve worksheet get built from the same handful of inputs. Whatever your demand doesn't lay out, the adjuster has to go assemble from the report themselves, and that assembly job is how a file quietly loses six weeks.

1. A number with its derivation showing.Not just the figure. What the WPI was, how you got to the rating string, what you did with the adjustments. An adjuster who can follow your arithmetic can put it straight into a memo. One who can't has to rebuild it before they can defend it to anyone.
2. Future medical in the doctor's own language.A bulleted list, not a characterization. The injections, the hardware removal, the medication management, the surgery the AME called more likely than not. Future medical is a reserve line item. Give it to them in a form that can go on that line.
3. Restrictions quoted, not summarized.Bullet them out. Restrictions are what drives the return to work analysis and the exposure that comes with it. They also tend to be the thing an adjuster finds out about late, which puts them right back in the reserve conversation they were trying to avoid.
4. Care that was recommended and never authorized.The pain management consult, the psych eval, the referral that sat. This is exposure already living in the file that frequently nobody has priced, sometimes including the adjuster. Putting it in front of them changes their arithmetic without you having to argue anything.

Two things I could never do much with

• Adjectives standing in for specifics."Significant," "extensive," "well documented." These are in nearly every demand and they read as zero, because nothing can be lifted out of them. Whatever the reader has to go assemble themselves tends to get discounted instead.
• A global number with no allocation.Reserves are kept in categories. A single lump figure has nowhere to go in their system, so the adjuster has to allocate it themselves before the file can move, which means guessing at your reasoning and then defending the guess. A demand that breaks the number out by bucket has already done the work that unlocks the authority request.

The actual reframe

Your demand is not really trying to persuade the adjuster... or the defense attorney. The adjuster is not the audience. The adjuster's supervisor is, and your demand is the exhibit that goes in front of them.

Applicant attorneys have told us that defense attorneys have said that the demand letters that they have received from those AAs (without knowing these letters were generated with Hey, Lucie) have been the strongest demand letters they've seen. This is not a rare occurence.

We hear that defense attorneys have admitted that, when they receive one of these demand letters, they literally copy & paste it within their own authority requests to their adjusters.

Hey, Lucie writes your demand letters so the adjuster can lift it more or less intact into their own justification. It goes straight to their supervisrs. Settlement stops being something they have to talk themselves into and becomes the cheapest way to close a file that's been on their desk too long.

That is the whole thing. Not a louder demand. A demand that's easy to justify & pay rather than creating more homework for the person you want to pay you.