Claim Work and Reporting
The Board establishes standards for making determinations.
During the February, 2006 meeting, the Board made several suggestions regarding claim work reporting at Board meetings. The Board asked the claim presentation to include the details regarding the requested expenditure including a case summary showing all known outstanding balances on medical bills; and in the event an emergency award has been made, clear details regarding which Board member made the award; when the award was made; how the emergency funds were spent; and how the emergency award has impacted (reduced) the current award.
For many years, Board staff would work up payment considerations for the Board on the Administrator's Brief form. This was done prior to the meeting and provided details concerning the claimant's request. In recent years, if the amount(s) that appeared to meet eligibility requirements differed from the claimant's request or medical providers had either agreed to or were considering agreeing to a settlement for less then the full outstanding amount, a second Administrator's Brief would also be prepared. For many years, the Board indicated decisions by executing pre-printed Award order forms at the meeting and the amounts would be filled in later based on the appropriate Brief. In recent years, the Award Order form with the award amounts filled in prior to the meeting has been used.
Various methods were used in an attempt to ensure accuracy such as labels affixed to the form. After the meeting, if an error had occurred, the Award Order form would be changed if the change resulted in a lower award amount. If the error would result in a higher award amount, the claim was taken back to the Board for additional consideration. If the error was made between line items on the form these would also be changed by hand. If a pre-approval had been awarded, but had not appeared on the form, these would be hand written in.
The Board will indicate an award by executing the pre-prepared Award Order form and initialing the Administrator's Brief upon which the information is based. Adjustments required during the meeting will be made by striking through with ink. No adjustments to the Award Order form will be made after the Board has executed the document. All required monetary changes will be brought back to the Board for a decision whether the change is an increase or a decrease.