Benefit Notices: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Why do so many claims administrators pay such little attention to benefit notices? Most insurance companies and third-party administrators consider drafting and sending out benefit notices to be nothing more than a clerical function, unworthy of an adjuster’s time or review. Consequently, errors are often made with some mistakes being downright cruel.

For example: In a death claim we have actually seen a benefit notice addressed to a deceased worker directing him to select a physician from the company’s MPN list before seeking medical care. In another death case a benefit notice was sent advising the deceased employee of a delay in issuing a liability decision. The notice further advised that in order to resolve the delay the administrator needed to take the worker’s statement. Incredibly, the deceased employee was asked to bring his death certificate with him when meeting with the investigator. Honestly, did the administrator even bother to read what they sent out? Apparently not.

We also reviewed a case where five denial notices were mailed out over a period of three-days, all in the same claim, each time correcting a minor error made in a previously issued notice. The injured worker did not care about the minor corrections being made. Instead, his attention was focused on the fact that his claim was denied five times. Talk about rubbing it in. Sending five denials in three days is enough to get anyone upset. As anticipated, these multiple denial notices prompted the injured worker to retain legal counsel.

Lastly, be cognizant of dates. It’s really sad when a denial notice is delivered to an injured worker on their birthday or on December 24^th.  Nothing like ruining someone’s Christmas. If possible, wait until after an event or holiday occurs before sending out a denial. It would be a considerate gesture and the proper thing to do.