Insurance & LiensQuestion 1623 of 1632

A laborer cuts his hand on Monday and needs stitches. He files the DWC-1 claim form on Wednesday. The carrier has neither accepted nor rejected the claim. What must the employer do, and how far does its liability run?

a.Wait for the carrier's decision, because no treatment need be authorized while a claim is pending
b.Authorize treatment by Thursday, with liability limited to $10,000 until the claim is decided
c.Authorize treatment by Thursday, and carry the full cost of whatever medical care is ordered
d.Authorize treatment within 90 days, which is also the deadline for rejecting the claim outright

Explanation

Two clocks run from two different events. The employer had one working day from notice of the injury to hand the worker a claim form. Once the worker FILES that form, §5402(c) gives the employer one working day to authorize all treatment consistent with the applicable guidelines, so a Wednesday filing means Thursday. Liability for that treatment is limited to $10,000 until the claim is accepted or rejected — the money is spent before anyone decides the claim, which is the point of it. Ninety days is a different deadline: it is when an unrejected claim becomes presumed compensable.

Law Reference: Labor Code §5401(a); §5402(b), (c)

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