Printer-Friendly Version

CHAPTER 2-200 - PRIMARY CASE REVIEW

1. Purpose and Scope. This Chapter provides an overview of the procedures for the initial review of a case file by the Claims Examiner (CE) or Claims Examiner Clerk (CEC).

2. Definition. A primary case is a recently created case that has not been reviewed by a CE or CEC. It usually contains only the initial report of injury and an indication of the employee's absence from work. However, often it will also contain other reports or information germane to the case. At a minimum such cases will normally contain at least one of the following reports or forms:

a. LS-202, Employee's First Report of Injury (Exhibit 16, PM 10-200)

(1). . . reporting lost-time beyond the date of injury,

(2). . . reporting a case of occupational disease, or

(3). . . reporting a case of permanent impairment which is covered by the schedule in section 8(c)(1)-(20) of the Act.

b. LS-206, Payment of Compensation Without Award or LS-208, Notice of Final Payment (Exhibits 19 and 20, PM 10-200).

c. LS-203, Employee's Claim for Compensation, or LS-262, Claim for Death Benefits (Exhibits 17, and 32, PM 10-200).

d. Settlement Application. Application for approval of section 8(i) settlement.

3. Timely Review of Primary Cases. Proper claims management dictates that primary cases be reviewed promptly to insure that compensation payments are provided on a timely basis, appropriate medical care is being provided and that the injured worker is promptly informed when entitlement to compensation is controverted by the EC. For this reason one of the Longshore Program's performance standards requires that primary cases be reviewed within thirty days of the date the case was jacketed. Generally, this will allow sufficient time for receipt by the DO of the initial evidence in a claim, i.e., the employer's report of injury, the attending physician's report, the employer's report of first payment of compensation or the notice of controversion.

4. Routine Cases. On receipt of primary cases the CE/CEC quickly analyzes the cases to segregate those which require full, systematic and thorough review from those which can be routinely closed or called up. In the routine type cases, frequently only one review of a case by a CE may be necessary. Such cases include those where lost-time did not exceed three days and no permanent partial disability is indicated, or those in which the appropriate payment for a short period of temporary disability has been paid and reported at the time of review. The initial review of routine cases by the CE/CEC should include monitoring for timeliness of required reports, completeness of the information thereon and review of the initial medical report for any treatment provided. More specific guidelines concerning this review are contained in PM 2-201 and 2-202.