Presentation on theme: "Overview of the Claims and Appeals Process February 2010."— Presentation transcript:
Overview of the Claims and Appeals Process February 2010
Learning Objectives Overview: ◦ Know the background of unemployment insurance. ◦ Understand what drives employer costs. ◦ Know what the employee is entitled to. ◦ Understand the critical points in the process. ◦ Review the appeals referee decision-making criteria.
Background The Social Security Act of 1935 established the unemployment insurance program to provide monetary benefits for a period of time to workers who have lost their jobs through no fault of their own.
Unemployment Benefits & Taxes ◦ Supported by federal/state taxes on an employer’s payroll. ◦ State administered. ◦ Regulations and tax vary for each state. ◦ State tax rate is a combination of a fixed tax and a variable tax.
Unemployment Benefits & Taxes ◦ Tax rate varies based on employer’s unemployment claims filed AND paid. ◦ Benefit eligibility and dollar amount determined by the state. ◦ Each state has minimum and maximum benefit amounts.
Critical Points in the Process Upon job loss, employee files claim with unemployment office. “Notice of Unemployment Benefits Filed” sent to employee’s former company. HR should review the claim notice immediately to determine validity of claim and respond quickly. If claim is granted or denied, claim be appealed by the losing party. A hearing usually follows where employer can provide supporting information.
Eligibility of Benefits If a former employee has lost her/his job through no fault of her/his own, she/she will be entitled to unemployment benefits. Claim should be e challenged to disqualify claimant for benefits, if it can be shown that former employee: ◦ had been dismissed for willful misconduct; ◦ was dismissed during the probationary period; or ◦ willfully left employment to take a job with another company.
Eligibility of Benefits Documentation is Critical! Examples include: Progressive discipline Exit/Separation interviews Resignation letter
Eligibility of Benefits “Should we always challenge a claim for benefits?” NO! Challenging a claim for benefits can cause a former employee to be disgruntled and bring a discrimination suit or other legal claim. It also allows plaintiff’s attorneys a chance at “free discovery” during the appeal process and will limit the grounds that an employer may later relay upon in defense of a subsequent discrimination lawsuit.
“Why was the hearing scheduled?” Original determination was appealed. “Why is it important?” The decision from the hearing replaces the determination that was appealed and to protect the council’s rights, we should participate. Otherwise, the council may receive an unfavorable decision. “What happens if we don’t participate?” Our evidence will not be considered and if we file the appeal, our case will be dismissed. “Can we request a postponement?” Yes, if there is a compelling reason.
Appeals Hearing Your Rights at the Hearing: 1.Testify in your own behalf; 2.Present documents and other evidence; 3.Question your own witnesses; 4.Question the opposing party’s witnesses; 5.Examine and object to evidence presented; 6.Explain or rebut evidence presented; and 7.Make a closing statement at the end of the hearing.
Appeals Hearing Appeals Referee Procedures at the Hearing: 1.Obtain permission to record from each participant and electronically record hearing; 2.Explain issues, purpose of hearing, order of testimony, and general procedures; 3.Identify the determination and contents of the case file; 4.Place all witnesses under oath or affirmation; 5.Question parties and witnesses to obtain the facts; 6.Assist parties as they question witnesses; and 7.Determine if testimony and documents being offered should be received and considered.
Appeals Hearing Evidence to Include at Hearing: 1.Testimony of witnesses who have first-hand knowledge of the events. 2.Any and all pertinent business documents. 3.Witnesses who can testify how the records were prepared and vouch for their authenticity. !Resend 2 nd copy of documents not included with hearing notice !All evidence becomes public record when hearing is convened !Once hearing is closed, no additional evidence will be accepted
Decision Process The Appeals Referee is required by law to be impartial and issue a decision based on competent evidence. A decision will be mailed to all party after the hearing, which will include: 1.findings of fact 2.conclusions of law 3.result - affirm, reverse, or modify the determination or dismiss the appeal determination or dismiss the appeal If you disagree with the decision, you can request review by the Unemployment Appeals Commission (UAC) within 20 days after decision was mailed.
Summary Documentation Determination of benefit eligibility UC Tax Rate
Resources www.fluidnow.com/appeals ◦ UC Law and Administrative Code Rules ◦ Unemployment Appeals Information ◦ Unemployment Claims