Pub. 1 2019 Issue 2

O ver 90% of Workers’ Compensation claims submitted to the NHADA Workers’ Com- pensation Trust are paid. However, not every medical condition, which develops while an employee is at work, is covered by workers’ compensation. Was there an incident in the workplace that caused the condition? Does the employee have a pre-existing condition, which re-occurred while the employee was at work? Was the employee injured outside of work and claiming the condition is work-related? Was the employee participating in horseplay? Was the employee under the influence of drugs or alcohol without the employer’s knowledge? Was the claim reported within the two-year statutory requirement? These questions and more must be answered during the investigation performed by the NHADA WCT claims team. The road adjuster, Deborah Handrahan, meets with the injured employee to get their side of the story. She meets with the employee’s supervisor or any wit- nesses to the reported incident. We obtain the medical records for treatment of the reported injury and any previous treatment for the same or similar condition. Once all of that information is collected, an appropriate determination can be made on the claim. The New Hampshire Workers’ Compensation Statute requires that every claim that is submitted is either paid or denied within 21 days from the date it is received in our office. If there is no medical treatment or not enough medical records received to make an accurate determi- nation, the claim will be denied. If there is not enough medical evidence, the claim will be reviewed weekly and when the medical records are received, a follow-up letter will be mailed to the injured employee either accepting or denying the claim. The injured employee has 18 months to request a hearing with the NH Department of Labor to appeal the denial, the aggrieved party has the right to appeal that decision to the Compensation Appeals Board (CAB) and the party aggrieved by that decision has the right to appeal the decision to the NH Supreme Court. The NH Supreme Court will accept cases when there has been an error in law in the Compensation Appeals Board decision. Decisions from the NH Supreme Court set precedent and are the basis for future determinations on similar claims. The New Hampshire Workers’ Compensation Statute, RSA 281-A:2 defines injury as an, “accidental injury or death arising out of and in the course of employment”… The Statute goes on to state that, “ Injury or personal injury PETER SHEFFER WCT DIRECTOR Why Are Claims Denied? 8 D R I V E