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How to avoid problems when denying workers' comp claims

As workers’ compensation defense attorneys, a great deal of our practice involves counseling employers on when and how to issue denials. Denying a work comp claim comes with its consequences, and more states are focusing on penalizing employers for unjustified denials. Moreover, a focus on the legal requirements behind denials has increased over the past few years. Because of this, it is important for employers to understand the steps and requirements behind workers’ comp claim denials.

This post will give a few helpful tips. 

Understand the rules – The rules in California are fairly specific as to what is required regarding which forms are to be used, and when they should be filed. If you are issuing a denial to a workers’ comp claim, be sure to understand the rules that govern claims.

Be certain about the information – The information you include in the paperwork submitted should contain only accurate information. In addition to personal information indentifying the worker (e.g. name, SSN, date of birth), it should also include the date the injury occurred as well as a short, detailed description of the injuries claimed.

A legal basis for the denial – Commonly, a specific legal reason is required before a liability claim is denied. It is not sufficient to simply indicate that a claim is not accepted. Without a legal basis for the denial, an employer could be held liable for improperly not honoring a claim. The language used in support of the denial should be simple and easily understandable.

Explain a worker’s rights – A short explanation of what a worker may do in the event they disagree with the denial should also be included.

If you have additional questions about your workers’ comp process, an experienced lawyer can help. 

Source: “Avoid penalties in work comp claim denials and errors,” July 17, 2014

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