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Adjusters Manual

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Adjusters must properly comply with the sections outlined below to correctly file a workers’ compensation claim.

All sections of the manual are published in Adobe PDF Format. You will need the Adobe Acrobat Reader installed to read it. If you don’t have Adobe Acrobat Reader, you can download by clicking here.

Introduction [PDF]

Staff Directory [PDF]

Investigating the Claim [PDF]

  • Reports of Injury/Determining Compensability
  • Denials

Medical Benefits [PDF]

  • Medical Payments
  • Preauthorization of Medical Treatment
  • Choice of Physician
  • Independent Medical Examination
  • Denial of Medical Benefits
  • Discontinuance of Medical Benefits
  • Most Common Reasons for A Form 27 to Be Rejected
  • Mileage and Meal Reimbursement Rates
  • Frequently Asked Questions

Medical Fee Schedule [PDF]

Indemnity Benefits [PDF]

  • Temporary Disability Benefits
  • Wage Statement
  • Certificate of Dependency
  • Temporary Partial Disability
  • Permanent Partial Disability Benefits
  • Agreement for Permanent Partial Disability
  • Lump Sum Requests
  • Permanent Total Disability
  • Death Benefits
  • Agreement for Compensation in Fatal Cases
  • Annual Adjustment of Weekly Compensation
  • Notice of Change in Compensation Rate

Vocational Rehabilitation [PDF]

  • Who Actually Provides Vocational Rehabilitation Services
  • Identification and Referral
  • Change of Rehabilitation Counselors
  • Entitlement
  • Return to Work
  • On-The-Job Training
  • Basic Education
  • Formal Training
  • Self-Employment
  • Progress Reports
  • Discontinuing Vocational Rehabilitation Benefits

Dispute Resolution Process [PDF]

  • Purpose of the Informal Resolution Process
  • Role of the Specialist
  • Standards of review at the Informal Level
  • Interim Orders
  • Settlement or Mediation

Arbitration [PDF]

Formal Hearing [PDF]

Interest Awards [PDF]

Settlement [PDF]

Appendices:
Appendix 1: Time Frames [PDF]
Appendix 2: Employer v. Independent Contractor
Appendix 3: Rule 40
Appendix 4: Workers’ Compensation Rules
Appendix 5: Hearing Decisions
Appendix 6: Workers’ Compensation Statute
Appendix 7: Workers’ Compensation Forms
Appendix 8: Initial Contact Letter
Appendix 9: Sample Wage Statements [PDF]
Appendix 10: Continuing Education Requirements