Worker's Compensation Survey
*
1.
Employee Name
(Required.)
*
2.
Employee ID Number
(Required.)
*
3.
Claim Number
(Required.)
4.
Did Claims Adjuster clearly explain benefits to you?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
5.
Was Claims Adjuster prompt/responsive to your questions?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
6.
Was Claims Adjuster helpful?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
7.
Did Claims Adjuster resolve your concerns?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
8.
Were your medical care needs met?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
9.
How would you rate your overall experience/interaction with the Workers' Compensation Division?
Excellent
Good
Average
Poor
Very Poor
10.
Please share any additional comments/suggestions to help us better serve you.
11.
If you wish to be contacted, please provide your phone number.