An Alternative Dispute Resolution (ADR) program, also known as a “Carve Out,” is designed to result in a system of benefits that mirrors the California Worker’s Compensation laws to help expedite and promote equitable resolution between injured workers and their employer and/or insurance company outside of the WCAB system, also known as the Worker’s Compensation Appeals Board which is run by the state of California.
In order to participate in an ADR under California Worker’s Compensation law, the employer or business entity must be a trade association, a group of employers or a sufficiently large employer. In addition, employees must be an organized labor union or designated Association. The employer and union must reach an agreement, often referred to as a collective bargaining agreement, to set up the rules so that the ADR program serves both interests.
Once an ADR program has been established under the collective bargaining agreement, a labor management committee is formed to oversee the program. The committee is usually comprised of an equal number of appointees from management and labor union or association. This committee approves the lists of primary treating physicians, qualified medical evaluators and other services such as interpreters that can provide services to injured workers and appoints the selection of the ombudsperson, mediators and arbitrators. These mediators and arbitrators are usually former or retired WCAB judges. The ombudsperson is the point of contact for both parties to help move the process along. The ombudsperson will recommend to the injured worker the appropriate medical treatments and other benefits as set forth in the carve-out agreement.
An ADR must be approved by the State of California and must mirrored the benefits provided under the California Worker’s Compensation appeals Board but can provide additional benefits. The main purpose of handling injured employee’s work injury and job accident claims through an alternative dispute resolution (ADR) program is to provide medical care in a much more efficient way than regular Worker’s Compensation which is fraught with delays due to a shortage of treating doctors and qualified medical evaluators (QME), cumbersome utilization review and independent medical review (IMR). With less delays in medical treatment delivery, ideally a swift return to work is anticipated for injuries that can be returned to regular work or be accommodated within restrictions. The concept is to streamline the process and reduce delays while saving costs for the employers, self-insured entities and workers compensation insurance companies. Most ADR programs have a designated process which provides access to neutral doctors and mediators to resolve all types of work injuries and any disputes regarding the different types of Worker’s Compensation benefits.
There are many different types of Workers’ Compensation ADR programs in California covering many professions and governmental entities. Many cities and counties utilize ADR programs as well as many trade unions such as carpenters, welders, retail clerks unions, police officer associations and many others.
Some ADR programs have rules regarding the attorney representation of injured workers at different stages of the proceedings, some allowed representation from beginning to end while others only allow attorney representation at the arbitration stage.
The work injury lawyers at Cleveland Metz has extensive experience in all types of ADR programs. Contact us to review your ADR agreement if you have any questions about your Worker’s Compensation case or want a free consultation to discuss the circumstances of your work injury and the system of benefits that applies to you.