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Glossary of WCB Terms

 

Administrative Determination Processing


Part 313 of Title 12 is REPEALED
and a new Part 313 is added to read as follows:

ADMINISTRATIVE DETERMINATION PROCESSING

Section 313.1. Statement of purpose.

To provide a fair, timely, and efficient mechanism for processing uncontroverted claims involving minor injuries, uncontested issues within a claim, and certain penalties.

Section 313.2. Issues subject to administrative determination processing.

  1. Any uncontroverted claims involving minor injuries, uncontested issues within a claim, and certain penalties which require a formal decision of the board may be considered for administrative determination processing, provided the issue is not in dispute based upon the evidence in the possession of the board and where the appearance of the parties will not, in the judgment of the board, add to the ability of the board to make a proper decision.
  2. Controverted cases shall be referred for a pre-hearing conference in accordance with subdivision 2-a of section 25 of the Workers' Compensation Law and section 300.33 of this Title.
  3. Cases where the expected duration of benefits is fifty-two weeks or less shall be referred for conciliation processing in accordance with subdivision 2-b of section 25 of the Workers' Compensation Law and Part 312 of this Title.
  4. Cases in which there has been, or may be, an illegal employment of a minor pursuant to section 14-a of the Workers' Compensation Law shall be referred for hearing processing.

Section 313.3 Procedure for administrative determination processing.

  1. All claims for compensation submitted shall be reviewed to determine whether any such claim is suitable for administrative determination processing, in accordance with the provisions of this Part. The board may request the claimant, employer, and/or its carrier to provide such additional information as the board may deem necessary.
  2. If the board determines that a case is suitable for administrative determination processing, a proposed decision shall be prepared and transmitted to the claimant, employer or its carrier, and any other party in interest. The proposed decision shall be dated the date it is transmitted. The parties shall also be informed of the date that the proposed decision becomes final, which shall be at least 30 days after the date it was transmitted by the board.
  3. Any party in interest may object to the proposed decision within 30 days of the date the proposed decision is transmitted by the board. Any objection must state the reason for the objection and identify the issues to be resolved. If an objection is received by the board within such 30-day period, the proposed decision will not be made final and the case will be scheduled for conciliation processing or a hearing before a Workers' Compensation Law Judge, or may be modified, as may be appropriate.
  4. All proposed decisions shall be reviewed and, if appropriate, approved by a Worker's Compensation Law Judge within 30 days of the date of the proposed decision. If the decision is not approved, the Workers' Compensation Law Judge shall refer the matter for a hearing, conciliation processing, or may modify the proposed decision, as may be appropriate. If the decision is approved by the Workers' Compensation Law Judge and becomes final, an application for review of such decision may be made in accordance with section 23 of the Workers' Compensation Law and section 300.13 of this Title.
  5. The proposed decision may contain an appropriate fee for the claimant's attorney or licensed representative.