Workers' Compensation Claims Examiner
U.S. Department of Labor
This position is located in the Department of Labor (DOL), Division of Energy Employees Occupational Illness Compensation (DEEOIC), Final Adjudication Branch (FAB).
Independently reviews the evidence of record and the recommended decisions issued by the DEEOIC District Offices for factual and legal accuracy prior to scheduling a hearing.
Responsibilities include, but are not limited to, the following:
Researching the associated employment-related illness; thoroughly reviewing and evaluating voluminous evidentiary documents (e.g., medical reports, employment evidence, hearing transcripts, exposure information, medical documentation, and other types of documents submitted to support a claim for benefits) from a variety of sources that the District Office used as the basis for the recommended decision; carefully analyzing, cross-checking, and interpreting data; and determining whether or not the recommended decision has been properly adjudicated.
Crafts a final decision to either affirm the recommended decision or remand the case back to the District Office for further development and the issuance of a new recommended decision.
Routinely weighs evidence and exercises sound legal judgment on the disposition of a case while clearly articulating factual and legal reasons for the acceptance or denial of a claim that can be upheld by any Federal district court.
Collaborates with other claims examiners and hearing representatives in adjudicating complex and unusual cases to ensure each case is properly reviewed and each decision is factually accurate. Conducts research into, and analysis of, complex court decisions, policies, and procedures.
Reviews claimant requests for reconsideration of final decisions with delegated authority to finalize or modify decisions of the initial claims examiner.
Qualifying specialized experience for the GS-13 is defined as:
Experience applying laws, rules, regulations, policies, and procedures when reviewing claims for benefits
Experience adjudicating highly complex cases for benefits based on evidence.
Experience reviewing reconsideration requests or appeals for benefits.
Experience making and issuing final decisions that affirm or remand cases for further development