Delays in Processing Workers’ Compensation Claims

Have You Received a FORM 3C Notice advising that your claim is pended?

If you have just answered YES then you should know:

• Ten days following receipt of the FORM 3C your claim is deemed to be disputed.
• Once the FORM 3C has been issued to you there is no legal requirement on the workers’ compensation insurer to progress your claim.
• The responsibility is on you, the injured worker to progress your claim.

FORM 3C

The purpose of a FORM 3C is to give the injured worker notice that the workers’ compensation insurer is not able to make a decision to accept or decline the claim within 14 days.

Common Reasons for Receiving a FORM 3C Notice

The most common reasons for not being able to make a decision recorded on the FORM 3C are:

• Insufficient medical evidence;
• Insufficient information regarding the circumstances of the injury;
• An independent medical review is required;
• The claim form is incomplete;
• The injury is not work related;
• The worker is not a worker under the law;
• The claim was not made in time; and
• The first medical certificate is not clear.

Delays

The delays occur because:

1. Workers’ compensation insurers:
2. do not have to follow up with workers for missing information on the claim form.
3. do not have to follow up with the doctor for further medical evidence.
4. do not have to follow up for further information regarding the circumstances of the injury.
5. do not have to arrange for an independent medical review.
6. Injured workers:
7. are not aware that once the workers’ compensation insurer issues the FORM 3C and provides reasons for not being able to make a decision it has complied with its legal obligations.
8. are not aware that the responsibility to progress the claim falls to them once they have received the FORM 3C.
9. are not aware that they are responsible for proving the claim and providing the workers’ compensation insurer with the information it lacks in order to determine liability.
10. are not sure how to progress the claim.

Injured workers who do not act immediately on receipt of the FORM 3C will suffer financially and may not be able to access proper medical treatment which may delay recovery.

If you receive a Form 3C and you have not heard from the workers compensation within 10 days after receiving the notice then you should seek legal advice.