Just as each state has its own unique laws and regulations governing its citizens, so do state DWCs. Each workers’ comp program sets its own legal obligations that the employer must meet. On the carrier side, DWC boards create rules that insurance companies must observe. Carriers train adjusters how to handle these claims.
Even when employers and carriers perform their obligations well, lawsuits can arise from workers’ comp claims. When this happens, the insurance carrier assigns a defense attorney who represents both the carrier and the employer. Doctors determine the medical cost, adjusters calculate lost time, and then expenses are added to determine the amount owed.
Regardless of the money finally awarded, the employer must always pay the claim (possibly increasing their MOD). But the defense attorney is there (if possible) to strike a balance between reducing the claim for their client while still being fair to the employee or their family.back