If the Fund delays deciding your case

It is the delay complaint of Article 7: a recourse before the Industrial Commission to obtain an order compelling the Fund’s Administrator to decide a complete case that has gone more than a month unresolved without justified cause.

The worker and the employer who are necessary parties in the case may bring it, and so may any interested party. The Act does not reserve the remedy to the injured worker.

• That more than a month has passed since the complete case was submitted to the Administrator’s consideration.Verified against the official source
• That the delay be without justified cause: the article says so in those words.Verified against the official source
• That the case be complete, that is, submitted to the Administrator’s consideration and not waiting on something from you.Verified against the official source
• Being a necessary party — worker or employer — or an interested party in the case.Verified against the official source

• Your Fund case number and the date it became complete: the month counts from there.
• A record of the steps taken with the Fund, which is what shows the delay does not depend on you.

1. 1

   Step 1: Check the article’s three conditions

   Article 7 does not say "if they take too long". It says the remedy lies "in the event the Fund Administrator delays for more than a month, without justified cause, the decision of a complete case submitted to their consideration". More than a month, without justified cause, and a complete case. If something of yours is still missing — an examination you did not attend, a document you did not turn in — the case is not complete and the clock is not running in your favour.

2. 2

   Step 2: Complain to the Industrial Commission

   The forum is the Industrial Commission, not the Fund itself. The Act says the worker or the employer as necessary parties, or any interested party, "may complain to the Industrial Commission and obtain an order from that Commission compelling the Administrator to decide the case". Act 45-1935 prescribes no form, fee or address for that complaint, so confirm with the Commission how it is filed: this guide does not invent a procedure the Act does not set.

3. 3

   Step 3: What the Commission can order

   First, an order compelling the Administrator to decide the case. And if necessary, the Commission "may also order the Administrator to remit the case file to that Commission in order to assume jurisdiction over it and decide it". That is, the case may end up being decided outside the Fund. That is the remedy’s ceiling.

4. 4

   Step 4: Before that, the Fund gets one last chance

   The same sentence sets the limit: "but, before assuming jurisdiction in a case and deciding it, the Commission shall give the Administrator a reasonable opportunity to close and decide that case". Worth knowing so you do not expect the Commission to resolve your case the same day: the Act designed the remedy to push the Administrator, and only if that is not enough, to replace them.

5. 5

   Step 5: If the problem is the treatment, not the decision

   They are two different paths. Article 7 serves when the case is not decided. When what fails is the medical care, the one that applies is Article 5: if the Administrator does not provide adequate assistance, the worker may go to the Industrial Commission, which, after investigation by a doctor designated for the purpose, shall order the assistance the case requires and the Administrator shall comply with that order. If you have both problems, they are two separate claims.

6. 6

   Step 6: The investigative powers behind all this

   The same Article 7 authorises the Administrator and the Industrial Commission, and the employees each designates, to summon witnesses, administer oaths and take testimony, issue subpoenas under warning of contempt, compel the attendance of witnesses and the production of documentary and any other evidence, and visit and examine buildings, machinery and other property where an accident occurred. They may also use the services of judges and prosecutors, marshals of the Court of First Instance and the District Court, the police force and agents of the Department of Labor and Human Resources and the Treasury Department. Article 8 adds the deposition and letters-rogatory machinery, and fixes the appearing witness’s stipend at six dollars ($6) for meals and lodging, plus transport.

Before Puerto Rico’s Industrial Commission, the body the Act empowers to order the Fund’s Administrator to decide. Act 45-1935 does not fix the form or the place of filing for the complaint: that is confirmed with the Commission itself.

• Using the delay complaint when a decision already exists: the Article 9 appeal is for that.
• Counting the month from the accident instead of from when the case became complete and was submitted to the Administrator’s consideration.
• Believing the remedy belongs only to the worker, when the Act also gives it to the employer as a necessary party and to any interested party.
• Expecting the Commission to decide the case immediately: it first gives the Administrator a reasonable opportunity to close and decide it.
• Filing the complaint with the Fund itself: the forum the Act names is the Industrial Commission.

These are the government pages this guide is based on.

• Corporación del Fondo del Seguro del Estado (CFSE)

  Fondo del Seguro del Estado

  bvirtualogp.pr.gov