Review of denied claims OK'd

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The state workers' compensation agency has agreed to reconsider denied claims dating back to July 1995.

Workforce Safety and Insurance responded favorably to a proposal from Rep. George Keiser, R-Bismarck, in which Keiser asked WSI to consider creating a process to reconsider claim benefit denials.

Claims filed after July 1, 1995, that resulted in a denial of benefits may be reconsidered if they fall in these parameters, according to a news release:

n No issues on appeal or under reconsideration;

n No reconsideration to issues reviewed by district or supreme courts;

n Requests for reconsideration must be made between January 2008 and the end of June 2008;

n Must sign a release allowing the review of relevant information.

WSIwill create an application form for injured workers to complete and make it available on the agency's Web site and at the agency's Bismarck and Fargo offices on Jan. 1.

The agency will create a team composed of its own claim supervisors, adjusters, attorneys and the Office of Independent Review; no employees involved in the original denial of the claim will be involved in the process.

When asked if using agency employees to review potential mistakes might be viewed as a conflict, Tim Wahlin, WSIlegal counsel, said the process of reviewing and adjudicating claims is so complex that to not have WSIstaff on it may make it worse.

"In candor, that's a fair accusation,"he said. "The flip side, though, is that nobody else knows how our benefit structure works or how it will be applied. It's such a complex process to make sure the right laws are applied from the right session."

At least five employees will be on the review teams, Wahlin said.

Wahlin said the agency wanted to make its decision-making process as transparent as possible.

"To the extent there are questions about the transparency of our decision-making process, and to the extent that in the past, there may have been a decision made in error, we're all about correcting that,"he said.

Findings will be reported to the Interim Workers Compensation Legislative Review Committee.

"To the extent that the North Dakotapublic doesn't believe we're doing this stuff right, we're going back and looking at it again,"Wahlin said. "I don't know how much more we can do."

(Reach reporter Crystal Reid at 250-8261 or at crystal.reid@;bismarcktribune.com)

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