An insurance company must accept or deny an injured worker’s claim for workers’ compensation benefits within 21 days of a reported injury. There are numerous different, and confusing forms the insurance company could issue. Each Notice of Compensation has a different legal meaning and impacts your right to benefits in different ways.
A Notice of Compensation Denial (NCD) means that your claim has been completely denied. The injured worker must file a Claim Petition to obtain wage loss or medical benefits.
A Notice of Compensation Payable (NCP) describes the specific injury the defendant is accepting, and the rate of wage loss benefits to be paid. If the claimant does not agree with the description of injury or rate of benefits, it is the injured worker’s obligation to file a petition to obtain correct and complete information. An insurance company is only required to pay for medical treatment for the specific injury described on the document. If the document only identifies minor sprains, strains or contusions, the insurance company is not required to pay for treatment of more serious injuries – even if they involve the same ‘body part’.
A Medical, or Medical Only Notice of Compensation Payable (MO-NCP) limits the insurance company’s obligation to pay for medical treatment for the specific injury described on the document. No benefits will be paid for lost wages. The injured worker must file any necessary petition to seek wage loss benefits, or to correct the injury description.
A Notice of Temporary Compensation Payable (NTCP) is exactly as described – it is temporary. This document provides the defendant up to 90 days to continue investigating the claim. Before the end of 90 days, the insurance company must accept or deny the claim. If the insurance company does not take any action at all, whatever information is listed on the Temporary Notice “converts” by law to an NCP. Whatever injury or period of disability was listed cannot be ‘denied’ by the defendant; but they can challenge the claimant’s right to future or ‘ongoing’ wage loss or medical benefits. If the claimant does not agree with the injury or period of disability described in the Temporary Notice, it is still the injured worker‘s obligation to file a petition to obtain a correct and complete description.
Issues can become even more confusing where an insurance company issues a Medical Only Notice of Temporary Compensation (MO-NTCP) – and during the 90-day temporary period issues a Notice with completely different injury or disability information; or where the insurance company issues a Notice of Temporary Compensation Payable (NTCP), paying wage loss benefits, but during the 90 days they change their mind and issue a Medical NCP – stopping the wage loss benefits, or an NCD – denying the claim entirely.
These documents are perhaps the most important forms in the entire Worker’s Compensation system. These documents define the rights, duties, options and obligations of the injured worker, the employer and the insurance company in regard to all future issues. The information on these forms determine whether the claimant or the insurance company has the burden of proving disability continues – or has ended; whether certain treatment must be covered; and even impact the possibility and value of a settlement of the claim. The impact of these forms on an injured worker‘s legal rights is very serious. It is essential that your work injury and period of disability are described correctly.
If you have suffered a work-related injury, you need the advice of a Certified Specialist in Worker’s Compensation claims, who can guide you through this complicated and confusing system. For a free, no-obligation consultation, call our Certified Specialists at 610-601-5399 or contact us online.