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work comp, work injury /

The Basics Of A Notice Of Insurer’s Primary Liability Determination

work comp, work injury /

If you suffer an on-the-job injury, you’ll report the accident to your manager or human resources, who will file what’s known as a First Report of Injury (FROI). The FROI acts as an official documentation of your injury, and your employer is required to submit one to their workers’ compensation insurance provider within 10 days of being notified of the injury if you miss at least three calendar days of work with your injuries.

Once the insurance company receives the FROI, they will read the report and begin an investigation of their own to determine if they will accept or deny primary liability for your injuries. They will do this by issuing a Notice of Primary Liability Determination. If they are denying liability, they have 14 days to issue this notice. In today’s blog, we take a closer look at the Notice of Primary Determination and walk you through your options based on what this report says.

Notice Of Primary Liability Determination Form

We’ll walk you through the Notice of Primary Liability Determination form on this blog, but you can check out what the form looks like by clicking here. When you receive this completed form from the insurance company, it can go one of a few different ways. They may:

1. Accept Your Claim With Wage Loss Benefits – This is the ideal scenario, as it means that your injury claim is accepted and benefit payments will start shortly.

2. Accept Your Claim But Wage Loss Benefits Not Paid – This could mean a few different things. If your employer reported your injuries but you did not miss at least three calendar days of work, although they accept liability, you do not qualify for work comp payments, and thus the insurer isn’t going to pay wage loss benefits. This could also mean that the insurance company needs more information before they move forward with wage loss benefits, but they still accept liability, so this is a preferred option as well.

3. Primary Liability Is Denied – This is the box that nobody wants to see completed, but it’s an unfortunate reality for many. If this section is completed, the insurer will need to provide you with an explanation for why they are denying liability. Some of the most common reasons for liability denial include:

  • Pre-existing condition
  • The injury happened outside of work or work duties
  • The employee did not inform the employer about the injury within the necessary timeline
  • The injury is determined to be “idiopathic” or without obvious cause
  • The employee is not actually covered by workers’ compensation (independent contractor, volunteer, etc.)

If your claim is denied, know that you’re not out of luck. Once you receive a notice that primary liability has been denied, you have three years to file a Claim Petition contesting the insurance company’s denial of liability. A workers’ compensation judge will review the facts of the case and make a determination unless the two sides can come to a resolution prior to this point.

We’ve helped countless clients fight back after receiving a notice that primary liability has been denied, and we can do the same for you. The insurance company doesn’t get to have final say, and if you truly believe that you should be eligible for benefits, connect with a workers’ compensation lawyer like Dean and the team at Margolis Law Firm. We’ll build a strong case and make sure that your Claim Petition showcases that you are in the right and your injuries should be covered.

If you want help with this process, or you want expert assistance with any other type of injury claim, pick up the phone and call Margolis Law Firm today at (952) 230-2700.

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