Administrative Review Program
The Administrative Review Program provides an independent review of an Order issued by an Attorney Specialist within the Benefit Review (Mediation) Program. It is available for Benefit Review Orders issued on/after May 26, 2010 for claims with a date of injury before July 1, 2014.
What is the purpose of Administrative Review?
The Program’s goals are to assure that Benefit Review Orders, whether awarding or denying benefits, are in accordance with the applicable workers’ compensation law, rules and regulations, policies and procedures, as well as case law. Doing so provides a more informal and cost-effective appeal process than through the state’s Court system.
Who conducts the Administrative Review?
The review is conducted by a senior Workers’ Compensation Attorney Specialist who had not participated in the earlier process. The review is conducted in an expedited and efficient informal conference over the telephone. In that conference, each party is able to explain the facts and issues involved in the workers’ compensation matter.
How is Administrative Review requested?
Either party may request the review by submitting a Request for Administrative Review Form C-44 (PDF) within seven (7) calendar days of his/her receipt of the Benefit Review Order.
An Informal Conference is conducted within ten (10) calendar days from the date the Division receives the Request for Administrative Review Form C-44 unless otherwise agreed by both parties. The Division must produce a new Order within seven (7) calendar days of the Informal Conference. The parties must comply with the new Order within ten (10) calendar days of the receipt of the decision.
How does Administrative Review function?
If the injured employee, employer or insurance adjuster disagrees with an Order issued by a Benefit Review Attorney Specialist the party may “appeal”, or request an Administrative Review, of the Order. Once requested, Administrator’s Designees within the Division will review all of the information and documentation in the case file and will conduct an informal conference over the phone before making a decision and issuing a new Order. General information that was available and could have reasonably been obtained and provided by a Party to the Benefit Review Specialists before the Benefit Review Order was issued will not be considered by Administrative Review except in very limited circumstances.
Need More Help?
If you have additional questions, please call 615-532-4812 or (800) 332-2667 or contact us by email at firstname.lastname@example.org.