Insurer Deny Responsibility

Questions and Answers

Why might the insurer deny liability?

There are a number of reasons why the insurer may deny liability for injury, weekly compensation, medical treatment or lump sum compensation. These reasons can include:

  • Injury was not sustained at work
  • The injured person is not a worker for the purposes of workers compensation
  • Employment was not a substantial contributing factor
  • If the injury is a psychological injury then the injury was wholly or predominately caused by the reasonable actions of the employer
  • Medical treatment is not reasonably necessary
  • Incapacity doesn’t result from the injury or there is no incapacity
  • There is no permanent impairment or the threshold requirements are not satisfied

What does the insurer need to include in a denial notice?

When the insurer denies liability for injury or weekly payments, medical or lump sum compensation they must provide a written denial notice to the worker. This denial notice should:

  • Set out the reasons for denying liability
  • List the documents taken into consideration in making the decision
  • Set out how to request a review
  • Where the worker can seek assistance
  • Where to go to dispute the decision

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