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