Adjudication

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Adjudication

The workers’ compensation system was developed as the sole remedy for employees injured on the job. This system acts to protect the employer from civil liability stemming from employment related injuries. Further, it was designed to provide workers with timely access to medical treatment and specific payment amounts for injuries occurring in the course of employment.

The Adjudication Division is the judicial arm of the Industrial Commission. The Division hears, reviews and rules on cases when a party to a claim files a complaint with the Industrial Commission. Full evidentiary hearings are held when requested or when necessary. Hearings are either held before a referee or the Commissioners. In their judicial capacity, the three Commissioners function as a three-judge panel.

A majority of workers’ compensation claims are resolved without involvement of the Adjudication Division. Cases that do require legal intervention are either processed through a formal hearing process or mediated through the Commission Alternative Dispute Resolution Program (ADR).

Over 1,000 complaints were filed with the Commission during Fiscal Year 2006. During this time, only 2.2% of all industrial accident claims were referred to the Division. There were 44,622 claims filed with the Industrial Commission, and the Adjudication Division held 120 hearings, issued 84 decisions, and mediated 881 claims.

The Commissioner, in conjunction with Benefits Administration, review and approve lump sum settlement agreements (LSSA). The Commission is bound by statute to review applications for settlement to determine whether all legal requirements are met, and to ensure the agreement is in the "best interests of all parties." LSSA agreements may not be approved for a number of reasons, but primarily for failing to show why the agreement factually supports the "best interest" standard.

A secondary function of the Adjudication Division is to settle disputes between sureties and medical providers. When a dispute arises, either the medical provider or the sureties can challenge contested charges and payments to the Industrial Commission for a ruling. The Commission will evaluate the evidence and then issue a binding administrative order to resolve the medical fee disputes.

ADR

The Alternative Dispute Resolution (ADR) program provides relief to the parties to a workers’ compensation claim by offering an efficient, quick, and cost-effective alternative to litigation. The goal of the ADR program is to resolve disputes quickly and eliminate the need for hearings or rulings on motions. Since the introduction of the ADR program in 1993 more than 5,404 claims have been mediated.

The Idaho Industrial Commission’s mediation services are free of charge, informal, voluntary, and are non-binding. Each negotiation is presided over by a trained Commission mediator. The services are available at any stage of a claim to assist the involved parties in reaching a successful resolution of the dispute. During the 2006 fiscal year, 830 out of 881 claims were successfully mediated. This represents a record 95% success rate.

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For comments or questions contact Megan Gale.