Enforcement & Effectuation
Compensation & REJECTION Orders
Effectuation of Settlements & Rejected Claims
Only the Commissioner of the Workmen's Compensation Commission is allowed by law with the authority to approve compensation orders on all settled claims and rejection orders on all denied claims. Only when a compensation order or rejection order filed by the Commissioner becomes final and legally binding will an employer is officially released of its workers compensation liability against a claim (unless an injunction relief is provided for the Commissioner to set such order aside).
No insurance carrier or employer is allowed to effectuate and enforce any order to reject or award a claim without first filing such determination with the Commissioner, whereby an order to reject a claim must be affirmed only when an employer disputes a claim through the filing of a proper Notice to Controvert Right of Compensation with the carrier and Commissioner, while a compensation order is affirmed by an approved settlement agreement successfully reached and signed by both parties.
An order can only be effectuated and considered final and legally binding when the first 30-days after the Commissioner files and signs such order fully expires. Within such period, the Commissioner may reconsider or revise such order and for either party to file an injunction relief to suspend or set such order aside. Once the statute of limitation expires, the filed order officially becomes final and legally binding.
Procedural on Filing Compensation and Rejection Orders before the Commissioner:
Compensation Order to Effectuate a Settled Claim
For any claim awarded and settled by the employer and its insurance carrier, an official notice is still required to be provided by the carrier to the employee in order to properly inform such employee of its determination. This also include providing the employee with a draft of the final settlement agreement to review and sign within 5-days upon receipt. Although both parties have reached and signed a settlement agreement, it is only when a compensation order is officially filed with the Commissioner will such an agreement can be legally effectuated and binding. Therefore, it is highly important for carriers to immediately file a compensation order on all approved claims with the Commissioner.
When both parties have successfully signed a settlement agreement, the carrier has 5-days to furnish and provide the following to the Commission's Office:
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3 copies of the signed settlement agreement to the Commissioner for filing as compensation order;
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a copy of all reporting forms by both employer and employee;
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a copy of the employee's impairment evaluation (if any);
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photos to facilitate disfigurement assessment by the carrier (if any); and
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any other record deemed necessary and relevant by the carrier for the employee's file with the Commission's Office.
Once the Commissioner signs and filed the compensation order, a 30-day waiting period is activated. Within this period, the Commissioner may reconsider such order or for either party to provide an injunction relief to set aside such order for reconsideration or further mediation.
Once the 30-day period fully expires, the filed compensation order both becomes final and legally binding. With the statute of limitation reached, any injunction or notice filed after the period expires is considered null.
Rejection Order to Effectuate a Denied Claim
For any claim controverted and rejected by the employer and carrier, a rejection notice is still required to be provided by the carrier to the employee in order to properly inform such employee of the determination made. It is important for carriers to ensure that any disputed claim must be properly contested by a Notice to Controvert Right of Compensation filed by the employer. Nonetheless, a claim can only be effectively denied when a rejection order is filed by the Commissioner (unless the employee files an injunction order with the Commissioner to set such order aside).
To file a rejection order with the Commissioner, the carrier is required to furnish and provide the following within 10-days after notice is given to the employee:
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a transmittal draft of the carrier's rejection order signed by both carrier and employer;
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the carrier's overall findings to clarify and justify why the claim is denied;
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a copy of the employer's filed controverted notice;
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a copy of all reporting forms by both employer and employee;
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a copy of the employee's impairment evaluation (if any);
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photos to facilitate disfigurement assessment by the carrier (if any); and
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any other record deemed necessary and relevant by the carrier for the employee's file with the Commission's Office.
Once the rejection order is filed, a 30-day waiting period is activated. The employee can also file an injunction relief during this period for the Commissioner to set aside such order, as well as the intent to file the unsettled claim with the Commission within 10-days.
Once the 30-day period fully expires, the filed rejection order becomes both final and legally binding. Any injunction or notice filed by any interested party after the period expires is considered null.