training adjudication workflow & analysis
TRANSCRIPT
Fact Finding Training
Adjudication Workflow & Analysis
FACT FINDING
What is the purpose of Fact Finding?
• To obtain a statement of facts
concerning a specific eligibility
issue
• To gather and record sufficient
facts to determine payment or
denial of benefits
The fact finding process is the most
important step in arriving at a quality
non-monetary determination.
FACT FINDING
What are good fact finding skills?
• Take the initiative in the discovery of
information.
• Obtain evidentiary facts, based on
evidence.
• Information gathered must be
sufficient to insure payment when
due.
• Obtain information promptly to
insure payment is not unduly
delayed.
FACT FINDING
What are the principals of fact finding?
• Maintain objectivity
• Be aware of the impact of language
• Understand the claimant’s point of
view
• Set aside prejudices – keep an open
mind
• Help the claimant feel at ease –
explain the reason for the interview
and steps that will follow
• Don’t patronize or put the claimant on
the defensive
• Listen for additional information in the
causal remarks
• Keep control of the interview
FACT FINDING
How to prepare for the fact finding
interview?
• Know your role – that of neutral
facilitator
• Understand claimant’s position – being
unemployed is stressful
• Know as much background as
possible – Review the entire claim,
related information available facts
gathered so far
• Make notes of information needed and
questions to ask
• Have necessary forms ready to
document statements taken
FACT FINDING
FACT FINDING
How to conduct an interview?
• Greet the party and introduce yourself
with your name and department
• Explain the purpose of the interview and
steps to be taken
• Show interest
• Keep alert
• Listen carefully
• Take statement from both claimant and
employer if appropriate.
• Advise that a determination will be issued
• Advise that appeal rights will be given
• Thank the individual
FACT FINDING
When conducting the interview...
• Keep it moving, but not so fast
that you miss information.
• Clear up points of confusion one
at a time.
• Keep interruptions at a minimum.
• Focus claimant’s attention on the
objective
FACT FINDING
What are pitfalls of interviewing?
• Listen to the tone of your voice
• Be careful not to patronize the claimant
• Do not embarrass the claimant
• Do not put the claimant on the defensive
• Do not show disapproval
• Do not show loss of patience
• Be careful of your choice of words
FACT FINDING
• Don’t ask leading or suggestive
questions
• Don’t ask multiple questions
• Don’t ask indefinite questions
• Don’t let the claimant draw focus away
from the issue with reverse questions
• Don’t jump to conclusions
• Don’t moralize, pass judgement or be
judgmental
FACT FINDING
How to handle difficult claimants?
• Remain objective – do not become
emotionally involved
• Speak softly – if you lower your
voice, the claimant will have to quiet
down to hear you
• Focus on the positive
• Explain you are here to help and
make the process as simple as
possible
FACT FINDING
What are the different types of information?
• Opinions – beliefs, notions or ideas that may or may
not be factual knowledge
➢ Example – “ I feel my supervisor did not like me”
• Assertions – positive declaration without attempt at
proof
➢ Example – “He didn’t like me because he felt I
was trying to take his job”
• Facts – Statements which are certainly and strictly
true
▪ General Facts - broad and can be interpreted in
several ways (Ex. I was late for work)
▪ Specific Facts – only have one meaning and can
be obtained by asking, ‘who, what, why, when,
where, and how (Ex. I was 15 minutes late)
FACT FINDING
Obtaining Rebuttals
When there are conflicts fact findings
gathered, rebuttals are needed from each
party to clear up the conflict.
When any potentially disqualifying
information is received from the employer,
the claimant should be allowed an
opportunity to provide a rebuttal.
The employer as an interested party and
should have the opportunity to give their
rebuttal.
FACT FINDING
How to document the facts?
• Record only pertinent facts –
omit extra nice to know facts
• Avoid being vague
• Be concise, specific, and
precise, using short sentences
• Review the statement and make
necessary changes
• Indicate whether the statement
was taken by telephone, email,
etc.
FACT FINDING
How to type a statement?
Always use the claimant’s wording:
First person: “I was discharged…” “I did
not report…”
Third person: “The claimant stated she
was discharged…”. “The claimant
stated he did not report…”
FACT FINDING
When facts are not available or it is not
possible to resolve conflicts, it must be
noted in the fact finding.
• General Fact Finding statements should
be used
When unable to contact a party:
• The contact attempt form must be used
which includes:
• Date and time the contact was
made
• Date and time a response should
be received by
• Method of the contact
FACT FINDING
Voicemail Message Script for the Claimant:
My name is _________ with the Department
of Economic Opportunity Reemployment
Assistance Program. This message is for
________. I need additional information on
your claim regarding ________. Please call
me back at 1-800-332-9341 ext._____, within
48 business hours, no later than MM/DD/YY
by _:__ am/pm. Failure to respond by this
deadline will result in a determination being
issued with the available information. Thank
you and have a great day.
FACT FINDING
Voicemail Message Script for the Employer:
My name is _________ with the Department of
Economic Opportunity Reemployment
Assistance Program. This message is for
________. I need additional information
regarding ________. Please call me back at
1-800-332-9341 ext._____, within 48 business
hours, no later than MM/DD/YY by _:__
am/pm. Failure to respond by this deadline
will result in a determination being issued with
the available information. Thank you and have
a great day.
FACT FINDING
FACT FINDING
FACT FINDINGWhat is the Reasonable Attempt Criteria?
• Any deadline set for receipt of information
must be reasonable and in no case less
than 48 business hours when responding
to a phone message/email.
• When responding to mailed
correspondence the deadline for receipt
of information must be in no case less
than 5 business days.
• Documentation must include the date,
time and name of the individual who
answered the telephone call, and that
failure to return the call will result in a
determination being issued using the
available information.
• All correspondence written in the course
of the investigation, must be uploaded to
the case file.
FACT FINDING
KNOWLEDGE CHECK
1. True or False. The purpose of the
fact finding is to gather and record
specific facts about an issue that
are sufficient to pay or deny
benefits.
2. True or False. Deadlines set for
receipt of information should never
by less than 24 hours.
3. What type of information should an
adjudicator obtain?
A. General Facts
B. Opinions
C. Specific Facts
D. Assertions
4. True or False. Rebuttals are
necessary when there are conflicts
in the fact finding.
QUESTIONS