See Workers’ Compensation Adjudicator 1

In the Department of Labor and Industries, this is the senior technical specialist level of the series. Positions at this level of the series require advanced knowledge over a wide range of specialty areas to perform reviews, conduct analysis, and make determinations on highly complex claims or workers’ compensation related issues.

Under general direction, positions at this level perform assignments in one of the following program areas:

• Claims Administration : Determines eligibility of workers' compensation claims for permanent total disability and/or death benefits and performs internal and external quality assurance audits of workers’ compensation claims and system; oversees the Over 7 reopening request for accident fund benefits and overpayment waiver process including research, file review and recommending Director approval or denial; determines eligibility for pension benefits or survivor benefits;

• Crime Victims Compensation: Determines eligibility of workers’ compensation claims for permanent total disability and death benefits.

• Self-Insurance: Serves as a pension adjudicator, determining eligibility of workers’ compensation claims for permanent total disability and death benefits; OR Serves as a penalty adjudicator, reviewing and determining appropriateness of assessment or denial of penalties against self-insured employers and third-party administrators per statute and rules.

• Fraud Prevention and Labor Standards: Reviews laws and issues decisions regarding highly complex and egregious fraud cases committed against the department including the amount of fraud overpayments and penalties to be assessed.

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;

Performs quality assurance and compliance audits of the workers’ compensation programs of all self-insured employers and their third-party administrators;

Adjudicates the Department of Retirement Systems death benefit claims;

Acts as Chief Adjudicator and assistant to 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 public; serves as final review of the department on protests or appeals on any determinations made in connection with claims for benefits under the Crime Victims Compensation Program;

Confers with Assistant Attorney General staff on cases in litigation and may be called to testify at the Board of Industrial Insurance Appeals;

Drafts replies for agency in response to inquiries from elected officials;

Conducts audits of State Fund and Self-Insured claims and benefits payment functions within Claims Administration, Legal Services, Regional Offices, and Pension Benefit payments; provides comprehensive written reports;

Reviews all claims appealed to the Board of Industrial Insurance appeals by an injured worker, beneficiary, employer, care provider or their lay or legal representatives and authorized to reassume jurisdiction of the claim from the Board for the purpose of addressing new issues raised by the appealing party or to engage in further negotiations toward settlement of the appeal;

Reviews and recommends revisions on the design and development of policies and procedures across programs within the Insurance Services Division: Fraud Prevention and Compliance, Employer Services, Self-Insurance, Office of the Medical Director, Health Services Analysis, Return to Work, Stay at Work, Legal Services, Retrospective Rating, and Administrative Services to mitigate systemic problems and achieve optimum effectiveness;

Reviews and determines appropriateness of assessment or denial of penalties against self-insured employers and third-party administrators;

Audits payments and activities connected to benefit payments for injured workers, pensioners, and beneficiaries;

Perform the duties of the lower level in the series;

Perform other related work as required.

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, human anatomy and physiology, 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 workers, 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.

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.

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

Successful completion of the Department of Labor and Industries Workers’ Compensation Adjudicator 2 Apprenticeship program

AND

One year of experience as a Workers’ Compensation Adjudicator 4.

Bachelor’s degree in business administration, public administration or closely allied field


Four years of experience in adjudicating workers’ or crime victims’ compensation insurance claims or adjudication of time loss payments.

Additional experience working with insurance claims, claims/insurance adjusting, claims investigations, disability management, claims risk management/loss control, medical billing, medical insurance, paralegal personal injury services or paramedical occupations will substitute, year for year, for required education.

Equivalent education/experience.

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.
Base range salary adjustment, revised definition, typical work, knowledge and abilities, and desired qualifications, and new class series concept, adopted June 22, 2023, effective July 1, 2023.
Revised legal requirements; effective June 6, 2024, due to adopted legislative action.
Revised definition, typical work, desirable qualifications, added distinguishing characteristics; base range increase from 58 to 59; adopted June 23, 2025, effective July 1, 2025.