Workers' Compensation Consultant Consolidated Series

California State Personnel Board Specification

Series established October 30, 1980

Scope

This series specification describes three classes to be used in staffing and supervising the professional activities of the Department of Industrial Relations' workers' compensation pro- grams including the Disability Evaluation Bureau, Self-Insurance Plans, Information and Assistant Programs, and the Uninsured Employers Fund.

Definition of Series

This is a general series designed to facilitate and foster an overall knowledge of and permit flexibility in the administration of workers' compensation rules, regulations, codes, and programs. Incumbents in this series will be expected to learn the entire scope of the work of the Department's workers' compensation programs, but will specialize in one branch of service.

Factors Affecting Position Allocation

Degree of supervisory responsibility, area of geographic concern, and�program and policy involvement serve as differentiating factors between individual classes.

Definition of Levels

Workers' Compensation Consultant

This is the full journey level. Depending on program assignment and under general direction of a Supervising Consultant, assists and advises employees, employers, insurance carriers, and public agencies concerning their rights, benefits, and obligations under workers' compensation laws and rules; develops, initiates, maintains, and audits workers' compensation, self-insurance plans, and/or disability evaluations; resolves issues and disputes arising under or concerning workers' compensation laws and its application; analyzes the applica tion of and enforces workers' compensation rules, regulations, pro grams, and laws; recommends settlements; analyzes, reviews, audits, adjusts, or investigates medical reports, industrial injury claims, wage information, occupational duties, or extent of compliance with workers' compensation coverage, laws, and programs; appears and testifies in pretrial hearings and judicial proceedings of Workers' Compensation Appeals Board; assists in training subordinate staff; and does other related work.

Supervising Workers' Compensation Consultant

This is the first supervisory level. Under general direction of a Workers' Compensation Manager, plans, organizes, and directs the work of subordinate staff in a major geographical area; provides training, evaluates performance, and recommends appropriate action; assists the staff with unusual or difficult cases; personally handles the more difficult, complex, or sensitive cases, audits, and program evalua tions; confers with the unit manager to assure uniform application and interpretation of program policies and procedures; confers with local Workers' Compensation Appeals Board Referees on integration of the work of ancillary and Judicial staff; discusses medical treat ment, disability, and insurance matters with physicians, attorneys, employees, and employers as needed; attends meetings and conferences to give advice and information on workers' compensation programs and policies; and does other related work.

Workers' Compensation Manager

Under only general direction, plans, organizes, establishes policies for, and directs and reviews the work of the staff of a workers' com pensation program depending on unit assignment, serves as expert consultant on disability evaluations, self-insurance, uninsured claims, or prelitigation resolution; selects, trains, and evaluates the performance of unit personnel; takes or recommends appropriate personnel action; maintains uniformity in the application of unit policy, procedures, rules, regulations, and appropriate laws; con ducts investigations for, discusses with, and advises the Workers' Compensation Appeals Board on appropriate workers' compensation problems; evaluates, analyzes, and makes settlement recommendations, and testifies at pretrial and judicial proceedings on the very difficult cases and settlements; gives speeches, writes articles, and�conducts courses in various workers' compensation fields; analyzes pending legislation and participates in recommending future legislation; and does other related work.

Minimum Qualifications

Workers' Compensation Consultant

Either I

One year of experience in California state service performing the duties of a Workers' Compensation Assistant, Range C. (Those with six months' experience may take the examination but may not be appointed until the completion of 12 months of experience.)

Or II

Experience: Three years of experience which must have been acquired in one or a combination of the following types of disability insurance:

1. Reviewing, investigating, or adjusting workers' compensation claims in a nonclerical capacity and with direct client appli cant contact for a workers' compensation carrier, public agency, or self-insured employer or such employer's adjusting agent. (California state experience applied toward this requirement must have been in performing duties of a class comparable to the level of a Workers' Compensation Insurance Representative II for at least one year.)

2. Performing claims examination work primarily of workers' compen sation insurance carriers and with responsibility for reviewing the work of others. (California state service experience must have been in performing duties of a class comparable to the level of an Insurance Examiner, Range E.)

3. Obtaining and analyzing medical, personal, and vocational information and using such information in the determination of�disability cases resulting primarily from vocational injury. (California state service experience must have been in performing duties of a class comparable to the level of a Disability Evaluation Analyst, Range C.) and

Education: Equivalent to graduation from college, preferably with emphasis in Insurance, Economics, Rehabilitation, Business Admin istration. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Supervising Workers' Compensation Consultant

Either I

One year of experience in California state service performing the duties of a Workers' Compensation Consultant.

Or II

Experience: Four years of experience which must have been acquired in one or a combination of the following types of disability insurance experience, at least one year of which shall have been in a supervising capacity:

1. Reviewing, investigating, or adjusting workers' compensation claims in a nonclerical capacity and with direct client appli cant contact for a workers' compensation carrier, public agency, or self-insured employer or such employer's adjusting agent. (California state experience applied toward this requirement must have been in performing duties of a class comparable to the level of a Workers' Compensation Insurance Representative II for at least one year.)

2. Performing claims examination work primarily of workers' compen sation insurance carriers and with responsibility for reviewing the work of others. (California state service experience must have been in performing duties of a class comparable to the level of an Insurance Examiner, Range E.)

3. Obtaining and analyzing medical, personal, and vocational information and using such information in the determination of�disability cases resulting primarily from vocational injury. (California state service experience must have been in performing duties of a class comparable to the level of a Disability Evaluation Analyst, Range C.) and

Education: Equivalent to graduation from college, preferably with emphasis in Insurance, Economics, Rehabilitation, Business Admin istration. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Workers' Compensation Manager

Either I

One year of experience in California state service performing the duties of a Supervising Workers' Compensation Consultant.

Or II

Experience: Five years of experience which must have been acquired in one or a combination of the following types of disability insurance experience, at least two years of which shall have been in a supervisory or managerial capacity:

1. Reviewing, investigating, or adjusting workers' compensation claims in a nonclerical capacity and with direct client appli cant contact for a workers' compensation carrier, public agency, or self-insured employer or such employer's adjusting agent. (California state experience applied toward this requirement must have been in performing duties of a class comparable to the level of a Workers' Compensation Insurance Representative II for at least one year.)

2. Performing claims examination work primarily of workers' compen sation insurance carriers and with responsibility for reviewing the work of others. (California state service experience must have been in performing duties of a class comparable to the level of an Insurance Examiner, Range E.)

3. Obtaining and analyzing medical, personal, and vocational information and using such information in the determination of�disability cases resulting primarily from vocational injury. (California state service experience must have been in performing duties of a class comparable to the level of a Disability Evaluation Analyst, Range C.) and

Education: Equivalent to graduation from college, preferably with emphasis in Insurance, Economics, Rehabilitation, Business Admin istration. (Additional qualifying experience may be substituted for the required education on a year-for-year basis.)

Knowledge and Abilities

Workers' Compensation Consultant

Knowledge of: Principles, practices, and procedures of the Califor nia Workers' Compensation System and Appeals Board; laws and rules of the Labor Code, California Administrative Code, and leading court decisions relating to workers' compensation coverage, insurance, enforcement, rights and benefits, rules of practice, interpretation, and application of the schedule of ratings to permanent disabilities, of physical and vocational rehabilitation, and of general account ing, auditing, and insurance principle applicable to self-insurance; medical and anatomical terminology; procedures used in treating industrial disabilities; occupations and their hazards, duties, skills, and physical requirements, and how to classify them accord ingly to such variations.

Ability to: Interpret, analyze, and summarize medical reports, fact situations, and workers' compensation laws and rules; determine the�significance of injury relative to occupational demands, make recommendations and mathematical calculations relative to the extent�of temporary and permanent disability and the Disability Rating Schedule; determine case reserves and whether proper medical treatment and benefits are being provided; make preadjudication recommendations for settlement; investigate, mediate, and conciliate claims and disputed issues; testify on direct and cross examination on the witness stand; prepare clear, complete, concise reports; communicate effectively; maintain cooperative relationships with those persons contacted in the course of work.

Supervising Workers' Compensation Consultant

Knowledge of: All of the above, and principles of personnel manage ment, training, and supervision.

Ability to: All of the above, and to plan, organize, and administer an area-wide program; interpret and apply the policies and procedures of the Division of Industrial Accidents and the Department of Indus trial Relations as that apply to the workers' compensation programs.

Workers' Compensation Manager

Knowledge of: All of the above, and division and department pur poses, policies, and procedures; principles and practices of public administration; medical and educational resources used in treatment of industrially disabled; history and development of California compensation law and of California and other disability rating schedules.

Ability to: All of the above, and plan, organize, administer, and evaluate the operation of statewide ancillary workers' compensation programs and program staff; coordinate activities, policies, and procedures with other units of the Division of Industrial Accidents and the Department.

Special Personal Characteristics

All Levels:

Willingness to travel and work irregular hours; possession of a valid driver license of the appropriate class issued by the Department of Motor Vehicles; tact, impartiality, and a neat personal appearance.

Class History