Occ. Code 6540200

COMPENSATION CLAIMS REFEREE, GRADE 28	6540200
SENIOR COMPENSATION CLAIMS REFEREE, M-4	6540300
SUPERVISING COMPENSATION CLAIMS REFEREE, M-5	6540500

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

Compensation Claims Referees adjudicate claims arising under the Workers Compensation Law, Disability Benefits Law, Volunteer Firefighters Benefits Law, and Volunteer Ambulance Workers Law. They review informal administrative determinations and proposed conciliation decisions; and conduct formal evidentiary hearings and render decisions.

Compensation Claims Referees are classified in the Workers Compensation Board and are assigned to eleven district offices located around the State.

DISTINGUISHING CHARACTERISTICS

COMPENSATION CLAIMS REFEREE: full performance level; independently conducts formal hearings in an assigned geographic region under the general supervision of a Senior Compensation Claims Referee.

SENIOR COMPENSATION CLAIMS REFEREE: first supervisory level; oversees the work of Compensation Claims Referees in an assigned geographic region, under the direction of a Supervising Compensation Claims Referee.

SUPERVISING COMPENSATION CLAIMS REFEREE: single-position class; assigned to central office; supervises field assigned Senior Compensation Claims Referees, and administers the adjudication process for the Workers Compensation Board throughout the State.

Reviews workers compensation claims cases and analyzes legal issues to determine whether the claim should be resolved through conciliation, pre-hearing conference, or Order of the Chair which allows medical providers to request WCB intervention whenever providers receive no response to a request for prior approval from a carrier for medical procedures, and determines the appropriate benefit.

· Performs legal research to determine the rights and responsibilities of the parties and to secure information to resolve outstanding issues.

· Approves, modifies, or rejects decisions submitted under the administrative determination and conciliation processes.

Conducts meeting(s), pre-hearing conferences with claimants and carriers attorneys and licensed representatives, expedited hearings and hearings on claims arising under the Workers Compensation Law, Disability Benefits Law, Volunteer Firefighters Benefits Law, and Volunteer Ambulance Workers Law; including discrimination hearings; denials of medical treatments and cases where the employer is not insured.

· Administers oaths; take affidavits and depositions; issues subpoenas to compel the attendance of witnesses and the production of books, contracts, papers, documents and other evidence; sets attendance fees for doctors scheduled to testify.

· Ascertains the rights of the parties; reviews evidence and evaluates lay and physicians medical testimony; orders medical examinations of claimants; determines questions of fact and of law, and makes findings.

· Confers with claimants, representatives and carriers at preliminary hearings to establish issues in controversy; determines witnesses need, time frames and schedules for hearings.

· Meets with the claimant and insurance carrier, claims adjusting company or self-insured in an attempt to bring all parties to an agreement concerning benefits due to the claimant or to resolve contested issues; refers claimants for rehabilitation evaluations and referrals.

· Presides over discrimination hearings where it is alleged that an employer fired or discriminated against an employee for filing or attempting to file a workers compensation or disability benefits claim.

· Presides over cases in which the employer is non-insured.

· Conducts hearings on denial of authorization for medical treatments or objections to medical bills raised by carriers.

· Orders investigations to ensure that employers comply with Workers Compensation and Disability Benefits Laws, Rules and Regulations.

· Determines whether Stop Work Orders were properly issued to employers when it is alleged that they are not in compliance with the Workers Compensation Law, Rules and Regulations.

Renders decisions on claims, approves and disapproves stipulations or waiver agreements, issues Notices of Decisions or Orders of the Chair.

· Imposes penalties on carriers, claimants, attorneys and licensed representatives for failure to comply with the Workers Compensation Law and its regulations; makes appropriate awards and fees to claimants attorneys or licensed representatives.

· Directs reimbursement to disability benefits carriers; employers, retirement systems where advance payment of compensation was made during pending claim.

· Directs investigation of physical conditions involving injurious exposures cases of occupational disease.

· Issues orders concerning the entitlement to medical benefits of injured workers under the Workers Compensation Law.

· Reviews and approves stipulations or waiver agreements ensuring that claimants rights are fully protected.

· Issues legal determination on the payment of medical bills disputed by the carrier.

Prepares correspondence, documents, and reports concerning claims and calendars.

Attends and participates in meetings and training sessions to keep abreast of changes in the Workers Compensation Law, Disability Benefits Law, Volunteer Firefighters Benefits Law, and Volunteer Ambulance Workers Law, rules, regulations and Board procedures, and case law.

SENIOR COMPENSATION CLAIMS REFEREE

Supervises the work of Compensation Claims Referees in the assigned district office.

· Schedules and assigns case workload.

· Provides training and instruction on Workers Compensation Law, Disability Benefits Law, Volunteer Firefighters Benefits Law, Volunteer Ambulance Workers Law, Board rules and regulations, Board determinations, case law, policies, and procedures.

· Evaluates performance and ensures hearings and conciliation meetings are conducted in compliance with established professional standards, and conform with law and procedures by monitoring decisions, actions, calendar and on-site observation and review.

· Consults with and provides guidance to Compensation Claims Referees and Senior Attorneys on matters of law, hearings and conciliation procedures to ensure consistent interpretations, sustainable rulings and decisions.

Serves as regional liaison with attorneys, licensed representatives, insurance carriers, union representatives, employers, claimants, physicians and/or other constituents, advising them on the rules, regulations, and policies of the Board.

Presides on cases and conducts hearings where necessary.

Attends meetings and prepares oral and written reports.

May supervise Senior Attorneys assigned to district offices.

SUPERVISING COMPENSATION CLAIMS REFEREE

Provides oversight and direction to Senior Compensation Claims Referees in the administration of adjudication processes.

· Establishes and reviews criteria, procedures and policies to ensure that workers compensation hearings and conciliation efforts are conducted in a professional manner and that rules and laws are consistently applied.

· Ensures consistency and quality of the adjudication process by interacting with senior staff and evaluating performance measures, rulings, management of difficult cases and the professional conduct of staff.

· Reviews narrative and statistical reports regarding administrative determinations, conciliation results, agreements reached, decisions and settlements processed.

· Identifies need and ensures the appropriate training and development of staff in all areas of responsibility.

· Conducts monthly meetings with the Senior Compensation Claims Referees and other staff to improve quality and productivity.

· Monitors and adjusts the flow of work to ensure the agencys clients and injured workers are afforded a timely response.

· Provides guidance to staff by discussing precedent cases, rules and regulations, or legislation and assist staff in resolving problems or interpreting policy, laws, rules, regulations and providing opinion on unique cases.

Presides over complex hearings or problematic cases.

· Reviews case and documentation and discusses issues with staff to gain familiarity with concerns.

· Elicits facts, takes testimony of witness, examines pertinent evidence, and confers with parties to ensure that the issues of law and proceedings are understood.

· Considers and evaluates information presented and issues a decision or negotiates a settlement.

Advises executive staff on the interpretation of legislation and impact on rules, regulations and policies of the Board pertaining to the adjudication process.

· Reviews and analyzes existing laws, rules and regulations and policies to determine intent, impact and effectiveness.

· Recommends areas of improvement and develops proposals to effect additions, modifications or deletions.

· Prepares detailed and justified recommendations to the Counsel for presentation to the Chair.

· Implements changes by providing direction to staff to adjust procedures, processes, systems and documentation.

· Performs legal research and analysis and prepares legal briefs.

Attends Board meetings, conferences, and workshops related to adjudication services.

Prepares written and oral reports regarding issues affecting the adjudication process.

MINIMUM QUALIFICATIONS

COMPENSATION CLAIMS REFEREE

Open Competitive: five years of legal experience subsequent to admission to the Bar of any state in the United States, which must have included one year of experience as follows:

in the practice of Workers Compensation Law, Volunteer Firefighters Benefit Law, Volunteer Ambulance Workers Benefits Law, personal injury law, or insurance claims laws; OR

as a judge in a court of record; or as an administrative hearing official presiding over adversarial proceedings, arbitration, or fact finding within a private or public tribunal; OR

combination of experience noted in A and B; AND

admission to the New York State Bar and being a member in good standing.

Promotion: one year of service as a Senior Attorney in the New York State Workers Compensation Board.

SENIOR COMPENSATION CLAIMS REFEREE

Promotion: one year of service as a Compensation Claims Referee.

SUPERVISING COMPENSATION CLAIMS REFEREE

Promotion: two years of service as a Senior Compensation Claims Referee.

Date: 8/09

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 that 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.

RELATED CLASSES