IWCI/ISIA Seminar, August 4, 2011
Claims Resolution
ROBERT FANNING
DUE DOYLE FANNING & ALDERFER, LLP
rfanning@duedoyle.com
The majority of workers' compensation claims in Indiana are resolved without an evidentiary hearing and determination by a hearing judge. If every claim were tried, we would need attorneys, more judges, more experts, more paper and the transaction cost for our system would be much higher than it is now. The Indiana workers' compensation system is premised upon each of us (claims professionals and attorneys) doing the right and reasonable thing when it comes to resolving claims. We have an obligation to encourage a prompt and appropriate resolution, and a failure in that regard may constitute a failure of diligence in adjusting or settling a claim and may lead to a penalty of up to $20,000 plus attorneys fees of up to $6,667 pursuant to Indiana Code 22-3-4-12.1.
There are several ways by which a claim may be resolved:
- Form 45442 Request for Assistance
- Form 1043 and Form 18875 Agreement to Compensation
- Stipulation of Facts and Award
- Section 15 Settlement
- Mediation
1.) Form 45442 Request for Assistance
- Case Coordinator/Ombudsman Involvement
- No Application for Adjustment of Claim Pending
- Informal Resolution of Misunderstandings
2.) Form 1043 and Form 18875 Agreement to Compensation
- To be used for the payment of compensation Due (TTD, TPD, PPI, PTD)
- Admission of Liability
- Accuracy is essential (Average Weekly Wage, Injury Accepted)
- Medical Exhibits and Waiver of Medical Evaluation for Permanent Injury
- Multiple Digit Loss Table
- Form 38911
- Statute of Limitation to Reopen
3.) Stipulation of Facts and Award
- To be used for more complicated facts
- Includes exhibits to substantiate determination
- Specificity with regard to future medical care
4.) Section 15 Settlement Agreement (IC22-3-2-15)
- Bonafide Dispute a necessary
- 7 Day waiting period
- Board Approval required
- Unrepresented parties
- Adequate Value must be considered
- Exhibits may establish dispute for value
- Release of Liability
- Waiver of right to reopen
- Death claims
- Third party claims
- Second Injury Fund
5.) Mediation
- Effective July 1, 2011 the Board may order mediation (consent of parties required)
- Voluntary Mediation
- Be prepared
- Participate
