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Workers' Compensation Q&A for Insurers
How do I file an Employer's First Report of Injury (FROI) with the Division of Workers' Compensation?
The FROI must be filed electronically (EDI).
Click here for more information
about electronic filing.
How do I file a Notice of Contest?
The Notice of Contest must be filed electronically (
). It cannot be filed unless an Employer's First Report of Injury has first been filed with the Division of Workers' Compensation.
How do I file an Admission of Liability with the Division?
An admission should be filed by mail. It must be filled out completely and accurately. Be sure to include a claims representative name, toll-free phone number, and address. Please note that the admission cannot be filed unless an Employer's First Report of Injury or a Workers' Claim for Compensation exists.
What should a Third Party Administrator (TPA) or insurance carrier do when it receives a Worker's Claim for Compensation?
Regardless of liability of the insurance carrier or TPA, a position (an Admission of Liability or Notice of Contest) must be filed with the Division within 20 days of receipt of the Worker's Claim. This is true even if the carrier or TPA has no record of the claim or of the employer.
When may I modify or terminate temporary benefits?
An insurer may terminate temporary disability benefits without a hearing by:
filing an admission of liability in accordance with Rule 6-1(A)(1) and attaching the supporting documentation to the admission
filing a Petition to Modify, Terminate, or Suspend temporary disability benefits for circumstances that do not fall under Rule 6-1(A) (see Rule 6-4)
a stipulated agreement between all parties
an Order of an Administrative Law Judge
Can earned sick leave or vacation pay be charged against a worker's compensation claim?
No. An insurer or TPA may not reduce or replace an injured worker's compensation benefits with sick leave, vacation pay, annual leave, or other similar benefits during the time that he or she is temporarily disabled by the injury.
What should I do if an injured worker dies from non-work-related causes?
If an injured worker dies from a non-work-related cause, you must file a Final Admission of Liability with the Division with a death certificate, letter, or obituary attached. Always state a position on fatal benefits.
Which pages of the Final Admission of Liability form should I send to the injured worker?
The Final Admission of Liability is a four-page legal document, all of which must be mailed to the injured worker and his or her attorney (if any), the employer, and the Division of Workers' Compensation.
How do I recover benefits which have been mistakenly admitted and paid?
Benefits paid pursuant to an admission may not be modified or recovered unilaterally. However, this may be accomplished by an Order from an Administrative Law Judge or a written stipulated agreement by all parties.
Is an injured worker eligible for temporary benefits for time missed from work while attending workers' compensation medical appointments?
Yes. Temporary partial disability (TPD) benefits are due to an injured worker if he or she loses pay while attending medical appointments. Sick or vacation leave cannot be used for this purpose, unless it is to make up for that portion of the lost pay for which temporary benefits do not compensate.
How are Social Security Disability payments offset against permanent impairment benefits?
For injuries occurring after July 1, 2010, Social Security Disability benefits are no longer offset against permanent impairment benefits. They still offset temporary and permanent total disability benefits.
How often do workers' compensation benefits change?
Every July 1, the following maximum benefits amounts are recalculated:
weekly rate for temporary total disability benefits
weekly rate of permanent impairment benefits
These amounts may be increased or decreased, or remain the same, depending on the state's economic circumstances.
Does it matter if the injured worker is a minor at the time of injury?
Yes. If the injured worker receives a whole person impairment or permanent total disability benefits are calculated using the maximum temporary total disability rate at the time of maximum medical improvement (MMI). Temporary benefits are unaffected by the age of the worker. For workers' compensation purposes, a minor is a person under the age of 21.
If I miscalculate the permanent partial disability (PPD) benefits on a Final Admission of Liability, may I file an Amended Final Admission with the correct figures?
Per Rule 5-9, within the time limits for objecting to the Final Admission of Liability, the Director may allow an insurer to amend the admission for permanency. As a practical matter, amended admissions which adjust benefits upward can be filed at any time without permission.
I have filed a Final Admission and now the injured worker has made a written request for a $10,000 lump sum on the permanency award. I don't want to pay the lump sum - what should I do?
The statute provides no grounds for objecting to the lump sum. You must calculate the 4% statutory discount and pay the lump sum requested.
How do I document the overpayment of benefits?
Explain the specific amount of the overpayment in the "Remarks" section of the Final Admission of Liability. Some types of overpayments may be collected from the claimant, while others can only be applied against future benefits. Place the amount of the overpayment on the "Overpayment" line at the bottom of the Benefit History.
Division of Workers' Compensation