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	Government of the United States Virgin Islands
	Department of Labor
	Workers Compensation
	Guide for dispute resolution & appeal...

INTRODUCTION

Various decisions are made during the course of a Workers’ Compensation claim. These decisions cover such things as the legality of the claim, the extent to which the injury or diseased disables the worker and how long lost wage benefits should be paid. These factual and legal matters are decided by the Dispute Resolution Unit in accordance with the Workmen Compensation Act and the policies of the Virgin Islands Workers’ Compensation Administration. There are also medical aspects to claims. For example, what is the type of disability? What is its cause? What proportion of the disability is caused by injury or illness? And what proportion is caused by other factors?
If you do not understand the reasons for a decision, or do not agree with a decision, you may wish to:

Get clarification of the decision
Appeal the decision
Get assistance from other sources

WHAT SHOULD I DO IF DON’T UNDERSTAND CERTAIN ASPECTS OF MY CLAIM?

You may request an Advisory Meeting which provides information on the law; administration rules, regulations, policies, procedures and forms; and your rights and responsibilities.

HOW DO I ARRANGE FOR AN ADVISORY MEETING?

You may call or request in writing for an appropriate time. At times, such meetings may be conducted by telephone at the convenience of both parties.

WHAT SHOULD I DO IF I DISAGREE WITH SOMETHING WORK ERS’ COMPENSATION HAS DONE WITH MY CASE?

You may request an Informative Conference for an opportunity to be heard concerning your disagreement. You will then be notified in writing when the conference will be scheduled.

WHAT GRIEVANCES AM I ALLOWED TO RAISE IN AN INFORMATIVE CONFERENCE?

Any action by the Administration you feel would affect you, such as (but not limited to) denial of a claim deemed not compensable; suspension, discontinuance, or termination of benefits; denial of health care authorization for medical treatment; denial of payment of a medical bill; or reimbursement for expenses.

WHO CONDUCTS THE INFORMATIVE CONFERENCE?

A duly authorized member of the Dispute Resolution Unit will control and conduct the conference in an informal manner.

WHEN WILL I KNOW THE RESULTS?

You will be orally informed of the Administration’s intention with regard to the proposed administration action at the termination of the conference. The determination may be confirmed by letter.

WHAT IF I DISAGREE WITH THE DECISION?

You are entitled to Mediation Proceedings by filing a Request for Mediation on a form provided by the Administration.

WHAT IS THE PURPOSE OF A MEDIATION PROCEEDING?

The purpose of Mediation Proceedings is to:

Informally resolve any issues between the Administration and any person affected by Administration action; between relevant parties;
Resolve disputes between relevant parties;
Set the stage for a formal hearing; or
Clarify and focus of the relevant issues to be presented at formal hearing.

WHEN WILL I BE TOLD OF THE RESULTS?

You will then have twenty (20) working days to dispute the decision. A letter opinion shall be transmitted within twenty (20) working days of the proceeding which will constitute a Decision on the Merits. This letter opinion shall become binding if no formal hearing is requested.

WHY WOULD I NEED A FORMAL HEARING?

The purpose of a formal hearing is to resolve disputes not resolved by previous dispute resolution methods. A formal hearing also creates a record of proceedings for review upon reconsideration and appeal.

HOW DO I GET A FORMAL HEARING?

Formal hearings shall be considered only after specific written objections to the letter opinion following a mediation proceeding. The proper form is provided by the Administration’s Dispute Resolution Unit. Written objections must be received within twenty (20) working days of the date of transmission of the letter opinion. The written objections must specifically address each and every matter contained in the letter opinion for which review is sought. Failure to object to any matter contained in the letter opinion shall be considered acceptance of it. If these objections are not received by the Dispute Resolution Unit(DRU) in a timely fashion, it shall be considered a waiver of the right to a formal hearing.

WHAT IF I DON’T UNDERSTAND THE FORMAL PROCEDURES?

You may request assistance from the EAU; request an Advisory Meeting; or exercise your right to legal counsel.

HOW WILL I KNOW THE RESULTS?

A written order shall be issued within thirty (30) working days of the end of the formal hearing which will be binding on all parties unless a Reconsideration is requested.

WHAT IS A RECONSIDERATION?

A Reconsideration provides an independent administrative review of the Administration’s order issued after a formal hearing. Reconsiderations are conducted by the Commissioner of Labor which may be obtained by the same procedure as that of formal hearing.

WHAT IS THE RESULT OF A RE-CONSIDERATION?

The Commissioner may issue a Final Order which agrees with the original order, or a remand order which returns the matter to the DRU for further proceedings along with the Commissioner’s recommendations.

WHAT IF I DO NOT AGREE WITH THE COMMISSIONER’S FINAL ORDER?

Appeals of the Final Order of the Commissioner may be made to the proper court by petition of a Writ of Review of the decision.

DO I NEED AN ATTORNEY FOR ALL THIS?

Attorney representation is not required. However, if you wish to retain legal representation, the attorney must file a written entry of appearance prior to participation. Henceforth, an attorney may not withdraw from representation except upon the written order of the Director after a showing of just cause.

WHO PAYS THE ATORNEYS FEE’S?

The basic rule is that each party is responsible for his or her own attorney’s fees. However, the Commissioner has the authority to approve the fee for attorneys appearing for employees should they so choose.

MAY I CONTACT THE WORKERS’ COMPENSATION ADMINISTRATION IF I HAVE FURTHER QUESTIONS?

You may contact your attorney or you may request an Advisory Meeting designed to provide information concerning the Act, Rules and Regulations of the Administration, the policies, procedures and forms utilized by the Administration and the rights and obligations of claimants, employers, and health care providers.