Dispute resolution

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Most claims are processed without incident. If a claimant disagrees with a decision that has been made regarding a claim, the claimant is urged to contact the claims examiner to see if the issue can be resolved. If the issue cannot be resolved, the claims examiner will inform the claimant of his or her options.  Options for resolving disputes include:

Lump sum settlement

In some instances, the State Insurance Fund and the claimant may agree to a lump sum settlement.  In exchange for a cash settlement, the claim is closed and cannot be reopened. All lump sum settlements must be approved by the Industrial Commission.  The State Insurance Fund will attempt to contact the policyholder before any lump sum settlement negotiations are held.

Mediation

Mediation enables the parties to negotiate their disputes in an informal, non-binding atmosphere. An Industrial Commission mediator facilitates a discussion between the claimant and the State Insurance Fund to work toward an acceptable resolution of the disputed matters. Policyholders are encouraged to attend the mediation sessions.

Hearing

If the dispute cannot be resolved, a claimant can elect to go through the formal hearing process. This proceeding brings the dispute before the three Industrial Commissioners or one of the Industrial Commission Hearing Officers. A hearing date is set for the evidence and legal arguments to be heard. The Industrial Commission will then consider the facts and issue a binding decision. This process generally takes six months to one year.

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