GQ Corner
Q. Once we receive a DWC-41, what do we need to do? This claimant had filed a workers’ compensation claim on 08/25/2018. The claim is still open.
A. I gather that while you just recently received the DWC-41, you received the claim more than 60 days ago, investigated it, and then took appropriate action. If so, then you do not need to do anything else. A claimant has one year to complete and file a DWC-41, so it is quite typical to receive them long after the claim has been either accepted or denied.
Q. We are seeking your legal advice on this claim. The employee reported that on 01/01/2019 she “finished her work for the day, she requested a Report Only for the pain she was feeling in her right arm that extends up to her shoulder. The pain returns periodically.” The employee reported the claim on 01/21/2019 and the client reported it to us on 01/27/2019. There is no medical on file and despite several attempts to reach the claimant by phone, we have not been able to secure contact or a recorded statement from the employee. Do we have grounds to deny? If so, please provide us with the appropriate verbiage to deny.
A. Yes, you have grounds to deny. You have no evidence of damage or harm (so no evidence of a compensable injury). The gist of your denial would be because the claimant merely reported pain to her employer and there is no evidence of an injury occurring within the course and scope of her employment. There must be evidence of damage or harm to the physical structure of the body sustained from a work-related activity or injury event arising out of or occurring within the course of her employment to have a compensable claim.
FOLIO
