If an employer directs you to deny a compensable claim, what is the proper action for a claims examiner?

If an employer directs you to deny a compensable claim, what is the proper action for a claims examiner?

• A. Ignore the employer
• B. Pay benefits if they are due
• C. Deny the claim based on information from the employer
• D. Deny the claim

Answer: (B)

The main idea is that a claims examiner must adjudicate based on the evidence and applicable laws, not on an employer’s directive. If the medical and factual evidence shows the claim is compensable and benefits are due, you must pay those benefits. An employer telling you to deny does not override the rules—you should gather the necessary information, apply the standard for compensability, and pay if due. Denying solely because of the employer’s instruction or relying only on information provided by the employer isn’t appropriate, and simply denying without basis isn’t correct.

The main idea is that a claims examiner must adjudicate based on the evidence and applicable laws, not on an employer’s directive. If the medical and factual evidence shows the claim is compensable and benefits are due, you must pay those benefits. An employer telling you to deny does not override the rules—you should gather the necessary information, apply the standard for compensability, and pay if due. Denying solely because of the employer’s instruction or relying only on information provided by the employer isn’t appropriate, and simply denying without basis isn’t correct.