The Workers' Compensation Unit administers the Commonwealth's workers' compensation program for injured state employees. The Unit consists of several sections to accomplish this task; claims adjusting, utilization review, rehabilitation, independent medical examinations, investigations, medical bill processing and operations. The Unit renders all claims decisions in accordance with MGL c 152. The sections are described in detail below:

Claims Adjusting: Responsible for approving or denying assigned claims and coordinating all aspects of claims management. Acts as the primary resource to the Workers' Compensation Agent.

Utilization Review: Responsible for reviewing medical treatment for appropriateness and necessity.

Rehabilitation: Consists of Medical and Vocational types. Responsible for working with the Office of Education and Vocational Rehabilitation to provide re-training for injured employees not able to perform their original work activities. Also responsible for negotiating all surgical fees as appropriate.

Independent Medical Examinations: Responsible for scheduling all independent medical examinations per MGL c 152 s 45.

Investigations: Responsible for coordinating with outside vendors on providing surveillence and other duties as requested.

Medical Bill Processing: Responsible for processing all approved medical bills associated with a claim.

Operations: Responsible for the oversight and management of daily office functions.

 

 


This information provided by the Human Resources Division

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