Troubleshooting Frequently Asked Questions
1. What’s the difference between a Claims Resolution Specialist and an Advocate?
The Claims Resolution Specialist is a neutral party who will work with the injured worker, the workers’ comp insurer and possibly providers to try and identify and resolve any issues in dispute. The Advocate is assigned to represent the injured worker when the issues can’t be resolved and a Mediation conference is needed.
2. Does the Claims Resolution Specialist work for the Insurance Company?
No. The Claims Resolution Specialist works for the Workers’ Compensation Board, a neutral party.
3. What is the purpose of Troubleshooting?
The Claims Resolution Specialist will work with the parties to identify any issues in dispute (payment of medical bills or lost time) and to attempt to resolve those issues. The Claims Resolution Specialist also responds to questions from the public, or any party, in reference to workers’ comp rules, regulations and process.
4. What if the Insurance Company continues to deny my claim after I’ve worked with the Claims Resolution Specialist?
The Claims Resolution Specialist can forward your claim on to the next step in the dispute resolution process called Mediation. The Claims Resolution Specialist can also make a referral to an Advocate on your behalf. An injured worker may also choose a private attorney to assist them in pursuing their claim.