Definition

Positions are allocated to one of the four defined separate program areas within the Department of Labor and Industries;

1. Claims Administration Program:  Determines eligibility of workers’ compensation claims for permanent total disability and/or death benefits.
2. Crime Victims Program:  Determines eligibility of workers’ compensation claims for permanent total disability and/or death benefits.
3. Legal Services Program: Supervises adjudicators in the Appeal Review Section, or determines if civil fraud was committed under Title 51.
4. Self Insurance Program:  Determines eligibility of worker’s compensation claims for permanent total disability and/or death benefits, or directs activities of the Self Insurance Claims Penalty Program or formal Training Program, including supervision of the adjudicative staff.

Typical Work

Responsible for adjudication of all phases of claims for fatal injuries, permanent total disability and pension claims by surviving spouses, children and dependents, including determination of diminution of disability; determines employer's eligibility for a reduction in financial charges assessed through entitlement to Second Injury Fund or Catastrophe Fund relief; issues formal orders concerning entitlement to benefits and employer assessments;

Supervises staff assigned to the Appeal Review Section and serves as lead consultant to that office; prepares status reports and maintains records on claims which have been appealed to the Board of Industrial Insurance Appeals or higher courts;

In the Self-Insurance Section, is responsible for supervision of adjudication and clerical staff and acts as Claims Manager and assistant to the Program Manager for Self-Insurance;

Acts as Chief Adjudicator and assistant to the Supervisor of the Crime Victims Compensation Program; assists the Supervisor in compiling and disseminating statistical, budgetary and other information regarding the section to the legislature and the general public; serves as final review for the department on protests or appeals on any determinations made in connection with claims for benefits under the Crime Victims Compensation Program;

Knowledge and Abilities

Knowledge of: Workers' Compensation and Medical Aid Acts and other statutes, court decisions, Attorney General Opinions, Board of Industrial Appeals rulings, and departmental regulations applying to industrial accidents and occupational diseases, past and present, or disability insurance provisions of the Old Age and Survivors Insurance Act; medical terminology, anatomy, psychiatric terms, drugs, prosthetic devices and their indications; tort law pertaining to third party actions.

Ability to: Exercise mature judgment in adjudicating disability claims and counterclaims from disabled persons, physicians, employers, third parties and other persons; personally make lawful and equitable determinations regarding eligibility for benefits under the law; write clear, concise, accurate and informative correspondence and reports; establish and maintain effective customer relations and working relationships with workers, physician, employers, legal representatives, co-workers and the general public; compare past records, past and present law, rulings of the Board of Industrial Insurance Appeals and higher courts, and other information to arrive at lawful and equitable decisions regarding benefit entitlements.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

Four years of experience in adjudication of workers' or crime victims' compensation claims with the Department of Labor and Industries, to include one year of experience as a Workers’ Compensation Adjudicator 4.

OR

Equivalent education/experience.

Class Specification History

Revised Spec. amended and title change (formerly Disability Claims Adjudicator VI) June 26, 1964
Revised definition, minimum qualifications, and general revision October 12, 1979
Revised definition May 11, 1984
Revised definition September 11, 1987
Revised Revises definition and minimum qualifications, title change (formerly Disability Claims Adjudicator 4) May 1, 1990
Revised definition and minimum qualifications: May 12, 2000
New class code: (formerly 47910) effective July 1, 2007