DISPUTE PREVENTION AND RESOLUTION. 3.1. The dispute prevention and resolution program shall consist of three components: Program Representative (Ombudsman) Mediation Arbitration. This program shall be used in place of the filing of an application with the WCAB. Any claim subject to this Addendum filed with the WCAB for resolution will immediately be removed and placed within the program established by this Addendum. This program is the sole means of dispute resolution and no dispute shall proceed to the California Workers’ Compensation Appeals Board until it has completed the processes defined and established by this Addendum. 3.2. The ADR process may be utilized for cases involving cumulative trauma provided that at least one of the employers is a participant in this agreement. The insurance carriers of previous employers may elect to participate in the ADR process provided they agree to be bound by the decision reached through the Mediation/Arbitration portion of this Agreement. When the ADR process is not utilized the cumulative trauma case will be handled through the current statutory process. 3.3. The Trustees shall provide for the preparation of explanatory material, which will be distributed to all current and newly hired employees employed by an employer subject to this Addendum, either before or after injury, or both. The material shall contain an explanation of the program and the rights and responsibilities of the respective parties and of the program representative, mediator and arbitrator. The material shall also contain an explanation of the employee’s rights to pre-designate his or her physician along with a pre- printed form to pre-designate a physician should the employee desire to do so. 3.4. The Trustees shall select at least one individual to serve as program representative, at least one individual to serve as mediator and at least one person to serve as arbitrator. Each individual shall be selected from a list of at least 5 candidates submitted by the Union, and may be discharged/removed at will by vote of the Trustees. 3.5. Program representatives, mediators and arbitrators shall be paid by the Trust Fund. The Trustees shall by rule establish a schedule for assessing participating insurance carriers and self-insurers the costs of operating the dispute prevention and dispute resolution program and other administrative costs of the program. 3.6. Subject to rules adopted by the Trustees, the program representative shall as soon as is practicable contact by telephone each employee who has sustained compensable lost time injury, to advise the employee of the existence of the program and its operation. Employees subject to this Addendum who believe they are not receiving workers’ compensation benefits to which they are entitled, including medical and hospital services, may notify the Program Representative by telephone. An employer may also request assistance from the Program Representative. The Program Representative shall attempt to resolve the issue(s) to the satisfaction of the employee. Within five (5) working days the Program Representative shall advise the employee of the position of the insurer or self-insured employer in terms which are readily understandable by the employee, and shall advise the employee of further steps the employee may need to take in order to reach a fair resolution including mediation and arbitration. The 5-day period may be extended by agreement between the employee and the Program Representative. Upon request, the Program Representative shall assist the employee in filing requests for mediation and arbitration related to alleged work related injuries and diseases subject to this Addendum. 3.7. The Program Representative shall maintain a log recording all activity including, but not limited to, dates and summaries of communications with employees, employers, and insurers, as well as any agreements to extend the time frames provided for in this Addendum. All written and oral communications involving the Program Representative shall be considered confidential pursuant to the California Constitution Article 1 Section 1 and pursuant to Evidence Code Sections 1115 et. seq.. 3.8. If a dispute related to a claim governed by this Addendum is not resolved pursuant to Section 3.1 within five working days from the employee’s contacting the Program Representative, the employee may request mediation services. The employer may also request mediation services related to any claim for benefits subject to this Addendum. No matter may proceed to mediation until completion of the five-day period and any agreed extension thereto. In no event may a matter proceed to mediation without first being presented to the Program Representative. 3.9. A request for mediation may be made no later than sixty days subsequent to the expiration of the five-day period and any agreed extension thereto. The insurer and employee may extend this sixty-day period by mutual agreement. 3.10. The Ironworkers Workers’ Compensation Trust Fund shall appoint a mediator within three
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Samples: Workers' Compensation Addendum, Workers' Compensation Addendum, Workers' Compensation Addendum
DISPUTE PREVENTION AND RESOLUTION. 3.1. The dispute prevention and resolution program shall consist of three components: Program Representative (Ombudsman) Mediation Arbitration. This program shall be used in place of the filing of an application with the WCAB. Any claim subject to this Addendum filed with the WCAB for resolution will immediately be removed and placed within the program established by this Addendum. This program is the sole means of dispute resolution and no dispute shall proceed to the California Workers’ ' Compensation Appeals Board until it has completed the processes defined and established by this Addendum.
3.2. The ADR process may be utilized for cases involving cumulative trauma provided that at least one of the employers is a participant in this agreement. The insurance carriers of previous employers may elect to participate in the ADR process provided they agree to be bound by the decision reached through the Mediation/Arbitration portion of this Agreement. When the ADR process is not utilized the cumulative trauma case will be handled through the current statutory process.
3.3. The Trustees shall provide for the preparation of explanatory material, which will be distributed to all current and newly hired employees employed by an employer subject to this Addendum, either before or after injury, or both. The material shall contain an explanation of the program and the rights and responsibilities of the respective parties and of the program representative, mediator and arbitrator. The material shall also contain an explanation of the employee’s 's rights to pre-designate his or her physician along with a pre- printed form to pre-designate a physician should the employee desire to do so.
3.4. The Trustees shall select at least one individual to serve as program representative, at least one individual to serve as mediator and at least one person to serve as arbitrator. Each individual shall be selected from a list of at least 5 candidates submitted by the Union, and may be discharged/removed at will by vote of the Trustees.
3.5. Program representatives, mediators and arbitrators shall be paid by the Trust Fund. The Trustees shall by rule establish a schedule for assessing participating insurance carriers and self-insurers the costs of operating the dispute prevention and dispute resolution program and other administrative costs of the program.
3.6. Subject to rules adopted by the Trustees, the program representative shall as soon as is practicable contact by telephone each employee who has sustained compensable lost time injury, to advise the employee of the existence of the program and its operation. Employees subject to this Addendum who believe they are not receiving workers’ ' compensation benefits to which they are entitled, including medical and hospital services, may notify the Program Representative by telephone. An employer may also request assistance from the Program Representative. The Program Representative shall attempt to resolve the issue(s) to the satisfaction of the employee. Within five (5) working days the Program Representative shall advise the employee of the position of the insurer or self-insured employer in terms which are readily understandable by the employee, and shall advise the employee of further steps the employee may need to take in order to reach a fair resolution including mediation and arbitration. The 5-day period may be extended by agreement between the employee and the Program Representative. Upon request, the Program Representative shall assist the employee in filing requests for mediation and arbitration related to alleged work related injuries and diseases subject to this Addendum.
3.7. The Program Representative shall maintain a log recording all activity including, but not limited to, dates and summaries of communications with employees, employers, and insurers, as well as any agreements to extend the time frames provided for in this Addendum. All written and oral communications involving the Program Representative shall be considered confidential pursuant to the California Constitution Article 1 Section 1 and pursuant to Evidence Code Sections 1115 et. seq...
3.8. If a dispute related to a claim governed by this Addendum is not resolved pursuant to Section 3.1 within five working days from the employee’s 's contacting the Program Representative, the employee may request mediation services. The employer may also request mediation services related to any claim for benefits subject to this Addendum. No matter may proceed to mediation until completion of the five-day period and any agreed extension thereto. In no event may a matter proceed to mediation without first being presented to the Program Representative.
3.9. A request for mediation may be made no later than sixty days subsequent to the expiration of the five-day period and any agreed extension thereto. The insurer and employee may extend this sixty-day period by mutual agreement.
3.10. The Ironworkers Workers’ ' Compensation Trust Fund shall appoint a mediator within threethree (3) working days of receipt of a request for mediation. Upon request by the employee, the Program Representative shall assist the employee in any mediation proceedings. The mediation process shall be subject to rules adopted by the Trustees.
3.11. The mediator shall contact the employee and a representative of the employer's insurer. Both the employee and employer's insurer shall supply the mediator with requested information. The mediator may meet separately with the employee and the representative of the insurer, and/or may schedule a mediation session to be attended by both the employee and the representative of the insurer. If the dispute is not resolved within fifteen ( 15) working days of the appointment of the mediator, the mediation process shall be deemed exhausted unless the employee and the representative of the insurer agree otherwise.
3.12. If a dispute related to a claim has not been resolved at mediation, the employee or representative of the insurer may request the Ironworkers Workers' Compensation Trust Fund to appoint an arbiter to arbitrate the dispute. Absent extraordinary circumstances, arbitration must be requested no later than sixty (60) days after the mediation process involving the same dispute has been exhausted or the date the parties have mutually objected to mediation. The Ironworkers Workers' Compensation Trust Fund shall appoint an arbiter within three (3) working days of receipt of a request. Upon request by the employee who is not represented by an attorney, the Program Representative shall assist the employee with procedural matters related to the arbitration, but shall not be permitted to act in the capacity of an attorney.
3.13. An employee receiving assistance from a Program Representative but who is not represented in the arbitration proceeding by an attorney shall be considered by the arbiter to be an "unrepresented worker.”
3.14. In conducting the arbitration, the arbiter shall apply the same presumptions of compensability, statutory construction and rules of admissibility of evidence that would be applied by a Workers ' Compensation Referee conducting a proceeding under the California Labor Code. The arbiter shall have the same authority as a Workers ' Compensation Judge over discovery, the production of documents, the issuance of subpoenas and other procedural matters related to the arbitration hearing.
3.15. Absent a contrary stipulation between the employee and the representative of the insurer, an arbitration proceeding shall be conducted at a location designated by the Ironworkers Workers' Compensation Trust Fund and no more than forty (40) miles from the residence of the employee if within California and otherwise at the offices of the Ironworkers Workers' Compensation Trust Fund or within forty (40) miles of the Ironworkers Workers' Compensation Trust Fund's offices.
3.16. All arbitration proceedings shall be electronically recorded. The original tape and record of the proceeding shall be retained by the Ironworkers Workers' Compensation Trust Fund. Copies of the recording and record shall be supplied to the employee and representative of the insurer upon request. A transcript of the proceeding shall be prepared upon the request of the arbiter, employee or representative of the insurer. Within ten (10) working days following the conclusion of the arbitration, the arbiter shall issue his or her written findings of fact, decision, order and, if applicable, award. The arbiter is authorized to include in any award all relief available from a Workers' Compensation Judge including but not limited to enhancements to compensation due to any unreasonable delay in the payment of compensation by the insurer as provided for by law, and/or relief under Labor Code Section 132a and/or Labor Code Section 4553 for injuries by reason of serious and willful misconduct, and/or attorneys' fees and costs. The arbiter is authorized to resolve all liens not settled by the parties , provided that written notice of the time and place of the arbitration is given to the lien holders advising them of their right to appear and present argument and testimony in support of their lien claim.
3.17. Any findings of fact, award, order or decision of the arbiter shall be in the same form and have the same force and effect as findings of fact, an award, order or decision of a California Workers' Compensation Referee.
3.18. The decision of the arbiter shall be subject to review pursuant to California Labor Code Section 3201.5(a)( 1) by the California Workers' Compensation Appeals Board in the same manner as provided for reconsideration of a final order, decision or award made and filed by a Workers ' Compensation Judge and by the California Court of Appeal pursuant to the procedures set forth in California Labor Code Section 3201.S(a)(l).
3.19. Nothing in this alternative dispute resolution process shall prevent an employee from retaining an attorney to represent the employee in any and all stages of the alternative dispute resolution process established by this Addendum. Such retention of an attorney is the sole and absolute choice of the employee. The retention of an attorney shall not diminish the ability of the Program Representative, Mediator, Arbitrator or case nurse to speak directly with the employee in the attorney's physical or telephonic presence. In no event shall the Ironworkers Workers' Compensation Trust Fund be liable for the expense of such representation. The terms and conditions of any agreement between an employee and the employee's retained counsel are not subject to this Addendum nor does this Addendum in any fashion alter or replace any or all California law applicable to an agreement between an attorney and a worker pursuing Workers ' Compensation benefits.
3.20. The California Ironworkers Workers ' Compensation Trust is to be created by an Agreement and Declaration of Trust effective as of January 1, 2003. Effective July 1, 2011 a contribution of three and one-half cents ($0.035) per hour for each hour paid for and/or worked will be made to the California Ironworkers Workers' Compensation Trust by all signatory employers whether or not they participate in the program established by this Addendum. These contributions will be subject to all the provisions of the Agreement and Declaration of Trust dated as of January 1, 2003 establishing that program and the provisions of the California Ironworkers Workers' Compensation Plan adopted by the Board of Trustees. It is understood said Workers' Compensation Plan shall be administered pursuant to the Trust Agreement. All rules of the Master Agreement relating to collection of delinquent contributions, and enforcement of the contribution obligation shall apply to the contributions provided for herein.
Appears in 1 contract
Samples: Workers' Compensation Addendum
DISPUTE PREVENTION AND RESOLUTION. 3.1. The dispute prevention and resolution program shall consist of three components: Program Representative (Ombudsman) Mediation Arbitration. This program shall be used in place of the filing of an application with the WCABprocess set forth in NRS 616C.295 through 616C.330, inclusive. Any claim subject to this Addendum filed with the WCAB Nevada Department of Administration Hearings Office for resolution will immediately be removed and placed within the program established by this Addendum. This program is the sole means of dispute resolution and no dispute shall proceed to the California Workers’ Compensation Nevada Department of Administration Appeals Board Office until it has completed the processes defined and established by this Addendum.
3.2. The ADR process may be utilized for cases involving cumulative trauma occupational disease claims provided that at least one of the employers employer with the last injurious exposure is a participant in this agreement. The insurance carriers of previous employers may elect to participate in the ADR process provided they agree to be bound by the decision reached through the Mediation/Arbitration portion of this Agreement. When the ADR process is not utilized the cumulative trauma case will be handled through the current statutory process.
3.3. The Trustees of the Ironworkers Workers’ Compensation Trust (“Trustees”) shall provide for the preparation of explanatory material, which will be distributed to all current and newly hired employees employed by an employer subject to this Addendum, either before or after injury, or both. The material shall contain an explanation of the program and the rights and responsibilities of the respective parties and of the program representative, mediator and arbitrator. The material shall also contain an explanation of the employee’s rights to pre-designate his or her physician along with a pre- pre-printed form to pre-designate a physician should the employee desire to do so.
3.4. The Trustees shall select at least one individual to serve as program representative, at least one individual to serve as mediator and at least one person to serve as arbitrator. Each individual shall be selected from a list of at least 5 candidates submitted by the Union, and may be discharged/removed at will by vote of the Trustees.
3.5. Program representatives, mediators and arbitrators shall be paid by the Ironworkers Workers’ Compensation Trust Fund. The Trustees shall by rule establish a schedule for assessing separate agreement with participating insurance carriers and self-insurers establish a method of reimbursement for the costs of operating the dispute prevention and dispute resolution program and other administrative costs of the program.
3.6. Subject to rules adopted by the Trustees, the program representative shall as soon as is practicable contact by telephone each employee who has sustained compensable lost time injury, to advise the employee of the existence of the program and its operation. Employees subject to this Addendum who believe they are not receiving workers’ compensation benefits to which they are entitled, including medical and hospital services, may notify the Program Representative by telephone. An employer may also request assistance from the Program Representative. The Program Representative shall attempt to resolve the issue(s) to the satisfaction of the employee. Within five (5) working days the Program Representative shall advise the employee of the position of the insurer or self-insured employer in terms which are readily understandable by the employee, and shall advise the employee of further steps the employee may need to take in order to reach a fair resolution including mediation and arbitration. The 5-day period may be extended by agreement between the employee and the Program Representative. Upon request, the Program Representative shall assist the employee in filing requests for mediation and arbitration related to alleged work related injuries and diseases subject to this Addendum.
3.7. The Program Representative shall maintain a log recording all activity including, but not limited to, dates and summaries of communications with employees, employers, and insurers, as well as any agreements to extend the time frames provided for in this Addendum. All written and oral communications involving the Program Representative shall be considered confidential pursuant to the California Constitution Article 1 Section 1 NRS 616B.012 and pursuant to Evidence Code Sections 1115 et. seq..NRS 616B.015.
3.8. If a dispute related to a claim governed by this Addendum is not resolved pursuant to Section 3.1 within five working days from the employee’s contacting the Program Representative, the employee may request mediation services. The employer may also request mediation services related to any claim for benefits subject to this Addendum. No matter may proceed to mediation until completion of the five-day period and any agreed extension thereto. In no event may a matter proceed to mediation without first being presented to the Program Representative.
3.9. A request for mediation may be made no later than sixty days subsequent to the expiration of the five-day period and any agreed extension thereto. The insurer or Third Party Administrator (“TPA”) and employee may extend this sixty-day period by mutual agreement.
3.10. The Ironworkers Workers’ Compensation Trust Fund shall appoint a mediator within three
Appears in 1 contract
Samples: Workers' Compensation Addendum
