The Claims Adjudication Process
The department is required to make a number of determinations that may effect your entitlement to benefits and/or the amount of benefits that are payable to you. When you called the Claim Center to file your initial claim for benefits, we looked at the amount of wages you had earned in the first four of the last five completed calendar quarters prior to the date you filed the claim to see if you had been paid enough wages to qualify. In some cases, we might look at alternative time periods to determine if you had been paid enough wages to qualify for a benefit. We mail a “monetary determination” to every claimant that explains the wages we have used to determine whether you have been paid enough wages to qualify for a benefit, and if you qualify, how much the weekly benefit amount will be.
Even if you were paid enough wages, you must still be unemployed through no fault of your own. If you have quit a job for reasons not related to something your employer did, you may be disqualified from receiving benefits until you go back to work, earn six times what your weekly benefit amount would have been, and then become unemployed again, through no fault of your own. If you were fired for misconduct, you may be disqualified from receiving benefits for not more than 12 weeks, nor less than six weeks. If you were fired for “gross misconduct” you may be disqualified from receiving benefits until you go back to work, earn six times what your weekly benefit amount would have been, and then become unemployed again, through no fault of your own. Certain payments made to you upon or after you became unemployed may result in a reduction in the amount of benefits paid for one or more weeks. In addition, in order to maintain your eligibility, you are required to be “able to work and available for work”, conduct a work search if instructed to do so, and must accept an offer of suitable work if one is made to you.
If we find there may be a question about your eligibility an issue or issues is created. Before we can pay any benefits, we have to investigate any of those issues and make a formal determination on your eligibility.
If there is an issue or issues that may prevent you from receiving unemployment benefits, participation in the adjudication and appeals process is the best way to ensure that your interests are protected.
Issues may be established based on information you provided at the time you filed your initial claim for benefits. They may also be established based on information provided by your most recent employer. The department sends a Notice of Separation to your last employer to obtain information necessary to determine eligibility, and asks that employer to tell us if they know of any reason or reasons that you should be disqualified. We also ask the employer to tell us about any payments made to you at the time you were separated or shortly thereafter, for example, vacation pay, wages in lieu of notice, severance pay, certain types of pensions or back pay awards.
If we become aware of an issue, you will be notified and given an opportunity to speak to a Claims Adjudicator before we make a determination. It is critical that you participate in this step of the process. If you don’t participate, but your last employer does, we may only get one side of the story and it could result in you being disqualified when perhaps you should not be. These notices are generally mailed at least one week prior to the date of the scheduled interview with the Claims Adjudicator. The interviews are conducted over the telephone. When you receive the notice in the mail, be sure to read it and, if for some reason you cannot be available on the day and time of the interview, you must call the claimant assistance line at 877-214-3332 and request to speak with a supervisor prior to your fact finding interview. There are limited reasons when a reschedule can be approved. During the interview, the Claims Adjudicator will ask you questions about the issue or issues and will also consider any information provided by your most recent employer. If necessary, the Claims Adjudicator will follow up on any conflicting information provided. Once the Claims Adjudicator has enough information, he or she will mail a written determination to both you and, in most cases, to your last employer.