Board Implements New Procedure for Expedited Determinations of Additional and Consequential Injuries

Beginning in December 2024, the Workers’ Compensation Board introduced a new procedure aimed at expediting decisions on additional sites of injury and consequential injuries. This procedural change significantly alters how claims will be processed when a claimant submits medical evidence supporting a new, unestablished condition.

What Changed?

Under the new policy, if the Board receives a claimant’s or claimant’s counsel’s Request for Further Action (Form RFA-1LC) accompanied by medical evidence on the record that meets the standard of prima facie medical evidence (PFME), the Board will issue a Proposed Decision finding PFME.

This step expedites the process by immediately moving the claim forward for determination, rather than waiting for a hearing.

Carrier and Employer Response

Unless the insurer believes the PFME finding was made in error, there should generally be no objection to the Proposed Decision. Instead, the insurer must take timely and strategic steps within 30 days of the Proposed Decision:

1. If accepting the new body part or condition
   • Notify the Board by filing a FROI-02.
2. If not accepting the new body part or condition
   • Begin developing the record promptly by either:
     • Obtaining an Independent Medical Examination (IME) within 60 days, or
     • Waiving the IME and cross-examining the claimant’s health care provider within 60 days.

Importantly, a Claimant’s Notice of Independent Medical Examination (Form IME-5) or proof of a testimony date must be filed before the Proposed Decision becomes final. Failure to do so may result in the Board deeming the insurer’s inaction as acceptance, leading to automatic establishment of the new site or condition. Therefore, always closely read what language the Proposed Decision contains. 

Next Steps After Finalization

Once the Proposed Decision is finalized, the Board will take further action. This may include:

• Issuing a Proposed Decision establishing the injury/condition;
• Issuing a Reserved Decision if the record is complete;
• Issuing a Proposed Decision directing depositions if a dispute remains; or
• Scheduling a hearing for additional record development, potentially leading to a bench decision.

Recommendations for Carriers and Self-Insured Employers

How to handle these changes?

• Actively track claims to flag Proposed Decisions immediately upon receipt, ensuring all deadlines are met.
• Coordinate quickly with medical vendors to secure IMEs within the 60-day window if the IME is needed. Scheduling delays could result in unintentional acceptance of new body parts or the Board finding that you waived the cross-examination of the IME.
• Prepare for cross-examinations proactively, including securing testimony dates before deadlines lapse, if the cross-examination is necessary.
• Evaluate claim strategy early, deciding whether to contest or accept new sites of injury promptly, as the window for action is not long and is now more rigidly enforced.