Occ. Code 6830500

 

INSURANCE FUND HEARING REPRESENTATIVE,

GRADE 22

6830500

SUPERVISING INSURANCE FUND HEARING

REPRESENTATIVE, M-2

6830800

 

New York State Department of Civil Service

 

Classification Standard

 

BRIEF DESCRIPTION OF CLASS SERIES

 

            Positions in this title series prepare and present workers' compensation claims cases at hearings before Compensation Law Judges or the Workers' Compensation Board and represent the State Insurance Funds (SIF) position at such hearings. They evaluate hearing proceedings and provide appropriate follow-up to decisions. 

 

These positions are found only at SIF. 

 

DISTINGUISHING CHARACTERISTICS 

 

INSURANCE FUND HEARING REPRESENTATIVE: full performance level; prepares difficult workers' compensation claims cases. 

 

SUPERVISING INSURANCE FUND HEARING REPRESENTATIVE: one- position class; formulates procedures and guidelines for all Insurance Fund Hearing Representatives. 

 

RELATED CLASSES

 

Unemployment Insurance Hearing Representatives prepare and present contested benefit claims and employer tax liability cases at quasi-judicial hearings before Unemployment Insurance Referees and the Unemployment Insurance Appeal Board.  

 

ILLUSTRATIVE DUTIES

 

INSURANCE FUND HEARING REPRESENTATIVE

 

Prepares and reviews assigned workers compensation claims cases. 

 

·        Assesses issues to be heard, such as Accident, Notice and Causal Relationship or questions of SIF coverage.

 

·        Examines case documents including medical documentation for periods claimed, consultants medical reports, and investigation reports.

 

·        Reviews relevant evidence of an accident, medical evidence of pre-existing disabilities, payroll records to verify average wages, and period of lost time, degrees of disability, and forms filed by claimant. 

 

·        Confirms that appropriate notice was given to claimant and that there is a causal relationship to the claimants employment. 

 

·        Reviews and requests medical, consultant and specialized investigation reports for occupation disease cases. 

 

·        Reviews formal proof of dependence such as marriage, death and birth certificates, and medical evidence for death cases. 

 

·        Searches the Workers Compensation Boards case folder for any documentation not in SIFs case folder.

 

·        Checks for any reports obtained from the New York State Index Bureau to support agency claims of a pre-existing condition in Second Injury cases. 

 

·        Arranges to subpoena witnesses such as employers, corporate officials, eye witnesses, doctors and specialists.

 

·        Collects and compiles depositions from witnesses and medical caregivers in accordance with New York Civil Practice Laws and Rules. 

 

Represents SIF at pre-hearing settlement conferences in an effort to settle cases without litigation under Section 32 of the Workers Compensation Law.

 

·        Interviews SIFs expert witnesses and cross-examines witnesses in cases involving complicated legal and medical issues and/or those cases with potentially extensive liabilities.

 

·        Argues the Funds position in the case, including questions of fact and law, and  objects to improper questions asked by the claimants attorney.

 

·        Argues against unreasonable penalties imposed by the Workers Compensation Board and adverse findings made by the Workers Compensation Board Law Judge, thereby protecting the record for possible appeal.

 

·        Negotiates with claimants attorney or representative for a possible settlement of the claim.

 

·        Argues and negotiates with representatives of other carriers and Special Funds for apportionment of SIFs liability.

 

·        Incorporates important medical and legal information into closing argument.

 

Performs  post-hearing activities. 

 

·        Compiles hearing reports by summarizing the claim and its history, the hearing proceedings, outcomes of the hearing, issues involved and details of testimony.  

 

·        Composes memorandums to Claims Services staff specifying the amount of award due and to whom payable (e.g., employer when claimant never lost wages or dependents in death cases). 

 

·        Issues recommendation for examination of claimant by the Funds doctor or an outside consultant.  

 

·        Compiles monthly statistical reports for  management.  

 

Drafts appeals of Workers Compensation Board decisions. 

 

Mentors and trains Claims Services staff.

 

 

SUPERVISING INSURANCE FUND HEARING REPRESENTATIVE

 

Participates in formulating standards, procedures, and guidelines for the program. 

 

Supervises Insurance Fund Hearing Representatives.

 

·        Oversees and advises Insurance Fund Hearing Representatives in preparing difficult, high cost claims cases. 

 

·        Directs training programs to ensure that all Insurance Fund Representatives Statewide are familiar with current Workers Compensation Law and Rules and department policies and procedures.  

 

·        Monitors staffs performance and directs related quality control studies. 

 

Serves as the Hearing Office liaison to other departments such as Legal or Claims. 

 

Reviews cases on appeal to the Board by either SIF or the claimant and personally litigates the most sensitive and high cost claims.

 

 

MINIMUM QUALIFICATIONS

 

INSURANCE FUND HEARING REPRESENTATIVE

Promotion:  one year of service at SIF as a Claims Services Representative 1, Senior Compensation Claims Examiner, Compensation Claims Investigator 2, or Medical Care Representative OR one year of service at SIF in a position allocated to Grade 18 or higher.

Open Competitive:

1.      Bachelors Degree and three years of experience as a Workers Compensation Board licensed representative or in representing or defending carriers, third-party administrators or self-insureds at hearings before any State or federal Workers Compensation Board, or working in claims examination, investigation, audit, adjustment or payment of lost time and permanency claims in accordance with State or federal Workers Compensation Law;  OR

2.      Bachelors Degree and four years of experience in representing or defending carriers, third-party administrators or self-insureds at hearings before quasi-judicial or administrative boards, agencies or hearing officers (i.e., arbitrations and mediations), or working in claims examination, investigation, audit, adjustment or payment of no-fault, casualty or similar insurance claims. 

 

SUPERVISING INSURANCE FUND HEARING REPRESENTATIVE

Promotion:  one year of service at SIF as an Insurance Fund Hearing Representative. 

 

Date:  12/08

 

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.