During the PWP (pay without prejudice) period, the injured
worker's benefits may be modified if the worker is partially
work capable, or refuses rehabilitation. Benefits may be
terminated if the worker returns to work, or is assessed to
be medically able to return to work, if the worker fails to
participate in a DIA review evaluation, an IME, or
submission of an earning's report, or in the case of death
or imprisonment. If the worker disagrees with a benefits
termination, he may file a claim with the DIA. The worker,
insurer, and DIA conciliator would then meet at a
conciliation (an informal procedure aimed at reaching a
voluntary agreement between the worker and insurer.) If
parties fail to reach a voluntary agreement, the worker and
insurer may present their arguments at a voluntary
arbitration, in which an arbitrator makes a binding decision
(which may be appealed.) If voluntary arbitration is not
successful, a conference- in which the worker and insurer
arbitrate to an administrative judge, who, within seven
days, issues a binding decision (which may be appealed.) If
this fails, the same administrative judge may conduct a
formal hearing ( both parties are sworn in, and rules of
evidence apply.) A binding decision is issued within 28
days, and may be appealed. If this decision is appealed, the
case is tried before a panel of six judges, or a review
board. If their ruling is appealed, the case is brought to a
Court of Appeals.
According to Brain and Conlon, work-related injuries result
in much more time out of work than non-work related
injuries. The reasons for this may include inadequacies of
the injured worker's medical provider system, lack of
motivation for injured worker, the injured worker's blaming
the employer, psychological factors of disability (
depression, low self-esteem, resentment), finances, or the
amount of paperwork involved. To decrease excess time out of
work, case management is suggested if: medical findings do
not account for some of worker's complaints, the worker
frequently changes treating physicians, the worker shows
signs of chronic pain, there is employer-employee hostility,
or the presence of psychosocial issues. The case manager is
responsible for assessing the extent, needs, and
consequences of the worker's injury, maintaining a rapport
of trust with the injured worker so that he may discuss job
satisfaction and desire for return, coordinate the injured
worker's return to work (co-attending physician visits,
becoming aware of worker's compensation guidelines,
acknowledge possibility of employer resentment toward
injured worker due to compensation premiums which rise
directly with claim cost), perform job analysis, and be in
constant communication with all parties involved in claim.