Program Description

The Commission adjudicates according to work related accident compensation law, the appeals conducted by injured workers and the employers that understand that they have been affected by a decision made by the State Insurance Fund Administrator. In addition, the Program must adjudicate those employee/employer controversies when they are from the jurisdiction of this organism.

Objectives

• To expedite the processing of injured worker and employer claims and appeals by developing a system that allows the different parties, through their legal representation or themselves, to file new case documents or include information about assigned or fulfilled hearings and any medical referrals via the Internet.

• To create informal meeting rooms. Informal meeting rooms are used by the Medical Consulting teams to expedite the hearings of injured workers and reduce the number of cases pending evaluation, thus maximizing the effectiveness of the Human Resources Department. Cases referred are those that do not require the attention of specialists and where agency's doctors can offer their expertise with minimum controversy. These rooms reduce hearings waiting times, as well as reducing the time to recommend a final determination.

• A procedure was established to handle the appeals presented under Brigido Berrios Case Doctrine, 102, D.P.R. 228. These appeals relate to those cases where an insurer does not notify the injured worker's lawyer, of the decision made. In order to expedite said appeals, they deviate from the ordinary procedure of the ordered public hearing and are referred to the Commissioners who study them. If applicable, Commissioners dispose of them through an administrative resolution. Eventhough this process has minimized the time to attend the claim and reduced the number of public hearings; it has increased orders for medical hearings and referrals to specialists.

• To process on appeals as stated in the Agency's mission. Over this past year, approximately 15% of the Corporation's decisions were appealed. Despite this number the agency continues to offer quality services by adopting procedures to quickly handle appeals and avoid prolonging decisions that may affect the health of injured workers and set back their rehabilitation.

Statistical Data	2010	2011	2012
Cases referred to specialists	8,716	9,152	8,969
Cases that award or increase disability	7,852	8,763	8,588
Medical hearings	22,317	23,872	23,395
Public hearings	19,175	20,512	20,102
Resolutions referred to other proceedings	23,557	24,876	24,379
Resolved cases	32,532	34,017	33,337

Customers

Injured workers and employers that file appeals with the State Insurance Fund Corporation.

Human Resources

Authorized and Proposed Positions	2009	2010	2011	2012
Managerial,Technical, Administrative, and Office Staff	79	78	77	80
Judges, Lawyers, and Legal Staff	46	49	49	52
Other staff	120	110	103	106
Other Safety and Protection Staff	19	19	21	23
Education and Recreational Services Professionals	13	14	13	15
Health Services	18	17	17	19
Total, Positions	295	287	280	295

FISCAL YEAR 2011-2012 ADOPTED BUDGET

The adopted consolidated budget for Fiscal Year 2011-2012 is $25,998,000. The funding comes from Other Income and its generated from occupational medical insurance premiums as established by Act No. 45 of April 18, 1935, as amended, known as the Workers Accident Compensation Act. This Act establishes that up to 4% of these premiums can be used to pay operational expenses. In addition, it establishes that the State Insurance Fund will be responsible for collecting the premiums and transferring the budget as approved by the Legislative Assembly.

This budget will allow the Commission to comply with the commitments imposed on by law, to review the decisions issued by the State Insurance Fund and ensure that injured workers receive the services to which they are entitled to: adequate medical treatment and fair and reasonable compensation.

Additional funding will allow the Commission to cover the cost of services at a data recovery centers, and in case of emergency to maintain Agency operations at all times, complying with the corrective action established by the Comptroller of Puerto Rico.

SUMMARY OF AVAILABLE RESOURCES