The Worker’s Compensation Board of Indiana offers a variety of alternative dispute resolution services to assist in the resolution of worker’s compensation injury disputes or issues between employees and employers and/or carriers without going through the formal hearing process. The informal dispute process is initiated by the filing of a completed Request for Assistance (State Form 45442) with the Board. The submission of this form authorizes the Board’s Case Coordinators to conduct an inquiry or investigation of the matter in an attempt to bring the claim to a resolution.
Upon receiving the Request for Assistance, the Case Coordinator assigned to the case will contact the involved parties and initiate an administrative inquiry. Ideally, disputes are resolved without going through the hearing process; however, if the response received is not favorable to the requesting party and the party wishes to appeal it, the only legal remedy is the formal hearing process. The issues commonly encountered in the alternative dispute resolution process include:
- Billing injured employees
- Delays and discrepancies in the payment of TTD/TPD benefits
- Disagreements about claims determination of compensability
- Disputes between carriers over cumulative injuries
- Insurance policy changes during an injury
- Premature termination of medical and disability benefits
- Proof of coverage issues
- Failure to report injury allegations
- Unpaid medical bills
In addition, the Board offers mediation services for formal and informal disputes. More information on mediation services can be found by following the link below:
Independent Medical Examinations
If the employee disagrees with the carrier's proposed termination of benefits, the employee must give written notice of disagreement to the board and the employer within seven days of receiving the notice of intent to terminate benefits. This can be done by checking any of the options that apply on the state form 38911 that is mailed to the claimant by the insurance carrier, and mailing the form to the Board. To ensure timely filing, the employee may also submit disagreement online by clicking here. Once the board has determined that the disagreement was filed in a timely manner and an independent medical examination has been deemed appropriate, the Board will distribute letters to the parties. Upon receiving these letters the claimant has twenty-one days to submit a response to the Board. Upon the timely filing of responses, the Board will set and schedule the independent medical examination. If the independent medical examiner determines that the employee is no longer temporarily disabled or is still temporarily disabled but can return to employment that the employer has made available to the employee, or if the employee fails or refuses to appear for the IME, TTD benefits may be terminated. If either party disagrees with the opinion of the independent medical examiner, the party shall apply to the board for a hearing under IC 22-3-4-5. Below are the reasons the employer may terminate temporary total disability benefits according to IC 22-3-3-7.
(c) Once begun, temporary total disability benefits may not be terminated by the employer unless:
- the employee has returned to any employment;
- the employee has died;
- the employee has refused to undergo a medical examination under section 6 of this chapter or has refused to accept suitable employment under section 11 of this chapter;
- the employee has received five hundred (500) weeks of temporary total disability benefits or has been paid the maximum compensation allowed under section 22 of this chapter; or
- the employee is unable or unavailable to work for reasons unrelated to the compensable injury.