Settlement and legal management

Question 1

When a claim denial is appealed, what are the four levels of litigation (APPEAL) that can occur?

Answer 1

• In-person Admin Hearing with Administrative law Judge (ALJ) at the WCB Hearings Division
• Board review of the ALJ’s opinion by the WCB
• Review by Oregon Court of Appeals
• Review by the Oregon Supreme Court

Question 2

What are two common settlement types in a DENIED claim?

Answer 2

• Disputed Claim Settlement (DCS)” settles ALL BENEFITS in the claim
• Stipulation and Order (Stip) : an agreement to RESCIND THE DENIAL and ACCEPT the claim

Question 3

What are the settlement options in an ACCEPTED claim?

Answer 3

• Claims Disposition Agreement (CDA)
• Disputed Claim Settlement (DCS) (if there is a PARTIAL denial in the claim
• Stipulation and Order (Stip)

Question 4

What is the only benefit a worker cannot settle when agreeing to a CDA?

Answer 4

Medical benefits

Question 5

How many days do insurers have to pay a CDA once it has been approved?

Answer 5

14 days from receipt of the approved order from WCB

Question 6

What are the following statements:

• Settlements should reduce uncertainty for the IW, employer, and SAIF
• Parties affected by settlements MUST BE FULLY informed
• The settlement value of a claim is the present value of probable claim benefits discounted by the uncertainty of entitlement
• Claims employees have an affirmative responsibility for anticipating and preparing for litigation and for considering settlement only after adequate preparation.
• Disputed claim settlements should be employed where issues lack clarity as to compensability, or benefit entitlement.

Answer 6

Settlement Tenets