If You Have a Dispute
Most claims are processed without incident. However, at times a dispute may arise between the parties. If you disagree with a decision that has been made concerning your claim, please first contact the claims adjuster to see if the matter can be resolved informally. If you feel the matter remains unresolved you have several options for resolving the dispute.
If you do not have an attorney, you can contact the Workers’ Compensation Administration.
- An ombudsman is an employee of the Workers’ Compensation Administration, who has been trained in the field of workers’ compensation law and can provide free assistance to injured workers, employers or other interested parties. They are required to maintain a neutral position when providing information or facilitating communication.
- The ombudsman will attempt to resolve the issue by facilitating communication between the parties. If resolution does not occur, the ombudsman will advise you of your options, and help in the completion of forms needed to file a Complaint with the Workers’ Compensation Administration.
- If a Complaint is filed a Mediation will take place. At the Mediation, the Mediator will again try and find a compromise that all parties are comfortable accepting. If this fails the matter will go to Formal trial in front of a Workers’ Compensation Judge.
You have the right to hire an attorney at any time to help you with your claim. If you hire an attorney, you will be responsible for half of the attorney’s fees, up to the current maximum of $16,500.00 + tax. The remaining amount will be paid by the employer/insurer. A judge must approve attorney fees prior to any payments being made.
Once you retain an attorney, legal protocol will require that all communications must be through your attorney. Your claims adjuster will be unable to discuss your claim directly