State of Washington Classified Job Specification
WORKERS' COMPENSATION ADJUDICATOR 2
Class Series Concept
NOTE: Level 2 complexity factors are determined by the Labor and Industries claims assignment system matrix.
Analyzes the medical file, obtains clarification by ordering consultations or independent medical exams. Reviews extensive vocational reports to determine and apply outcomes regarding a claimant's ability to work;
Evaluates and authorizes or denies requests for medical treatment, surgery, diagnostic studies, transfer of physicians and reimbursement of claimant's travel expenses;
Responds to telephone and written inquiries from physicians, employers, claimants and attorneys regarding a claim's status and the department's rules and regulations; composes medical examination and investigation assignments and legal orders;
Reviews decisions, claims files and examines medical reports to determine permanent partial disability; authorizes and processes appropriate awards; receives, reviews and authorizes or denies requests for lump sum payments and advances on permanent partial disability awards;
Receives and processes liens or other reductions in benefits;
Determines employability or eligibility for vocational services; refers for vocational services;
Adjudicates protests to determinations made regarding entitlement to benefits under the Industrial Insurance Laws;
Perform the duties of the lower level in the series;
Performs other related work as required.
Knowledge and Abilities
Ability to: exercise mature judgment in adjudicating disability claims and counterclaims from disabled workers, physicians, employers, third parties and other persons and 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 claimants, physician, fellow employees, and the general public; compare past records, past and present law, Industrial Insurance Appeals Board rulings and higher courts; compute valid lump sum payments for past unpaid time loss accurately; abstract pertinent medical psychiatric and other clinical information from hospital and Labor and Industries records.
Successful completion of the Workers’ Compensation Adjudicator 2 Apprenticeship program.
Three years of experience working with insurance claims, claims/insurance adjusting, claims investigations, or paramedical occupations.
A Bachelor's degree.
One year of experience in adjudicating workers’ or crime victims’ compensation insurance claims, or adjudication of time loss payments.
Class Specification History
Revises definition and minimum qualifications, adds distinguishing characteristics, title change (formerly Worker's Compensation Claims Specialist): May 1, 1990.
Class code change (formerly 4764): July 1, 1991.
New class code: (formerly 47881) effective July 1, 2007.
Base range salary adjustment, revised definition, distinguishing characteristics, typical work, knowledge and abilities, desirable qualifications, and new class series concept, adopted June 22, 2023, effective July 1, 2023