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