Workers' compensation claim acceptance or denial

The insurer said my claim is deferred. What does deferred mean?

The insurer has 60 days from the day you filed the Form 801 with your employer to timely accept or deny your claim. Until the insurer accepts or denies the claim, the claim is considered deferred. During this deferral period, you may be eligible for interim time-loss benefits, but medical bills and out-of-pocket expenses will not be paid unless the claim is later accepted.

How will I know if the insurer has accepted or denied my claim?

The insurer has 60 days from the day you filed the Form 801 with your employer to issue a timely acceptance or denial of your claim.

If your claim is accepted, the insurer will send you a Notice of Acceptance. The notice will list the accepted medical conditions.

If your claim is denied, the insurer will send you a letter of denial and tell you about your appeal rights in the denial letter.

What if I disagree with the insurer’s decision to deny my claim?

If your claim is denied, the insurer will tell you about your appeal rights in the denial letter it sends to you. We encourage legal representation when appealing a denial. Refer to: Need legal advice.

What if the insurer omits a medical condition from the Notice of Acceptance or I believe a new medical condition should be included?

If you believe that a condition has been left off the notice, the notice is otherwise incomplete or incorrect, or you believe a new medical condition should be included, you must notify the insurer in writing. The insurer has 60 days from the receipt of your written request to accept or deny the new or omitted medical condition.