Claim closure and closed claims Flashcards
What information is needed before closing a claim?
Medically Stationary status (Med. Stat.)
Work release information
Work status information
Information concerning permanent impairment
How many days do insurers have to close a claim?
14 days upon receipt of the information that qualifies the claim for closure
How many days does the IW have to appeal the Notice of Closure (NOC)
60 days from the mailing date
How much time does an insurer have to respond to the attending physician’s request for palliative care?
30 days from receipt of the request.
(SAIF) encourages an immediate response
What are the elements of a compensable aggravation claim?
An actual worsening
After the last arrangement of compensation
On an accepted claim
Established by medical evidence
Supported by objective findings
How many years does an injured worker have to file an aggravation on a disabling claim?
5 years from the date of the first notice of closure
How many years does an IW have to file an aggravation on a Non Disabling claim
5 years from the date of injury
When is the first time loss TL payment due on an aggravation claim
14 days from receipt of a written report verifying the worker’s inability to work
How many days does an adjuster have to issue a decision in an aggravation claim?
60 days from request to reopen the claim
