IW files a claim on 9/3/07 with a DOI of 8/29/07. There is no documentation to support the injury and the IW was terminated 5/30/07. You should:

IW files a claim on 9/3/07 with a DOI of 8/29/07. There is no documentation to support the injury and the IW was terminated 5/30/07. You should:

• A. Deny
• B. Accept
• C. Delay and investigate
• D. Close the file

Answer: (A)

In a California SIP, coverage generally applies only to injuries that occur during active employment with the SIP employer. If the employee is terminated before the injury date, any injury occurring after termination isn’t covered, so the claim isn’t eligible for benefits. Here, the worker was terminated on 5/30/07 and the injury date is 8/29/07, with no supporting documentation. That means there’s no basis for benefits and the appropriate action is to deny the claim. Delaying or investigating wouldn’t create coverage when the injury occurred after employment ended, and while closing the file might happen after a denial, the proper initial step is to deny based on lack of coverage and documentation.

In a California SIP, coverage generally applies only to injuries that occur during active employment with the SIP employer. If the employee is terminated before the injury date, any injury occurring after termination isn’t covered, so the claim isn’t eligible for benefits. Here, the worker was terminated on 5/30/07 and the injury date is 8/29/07, with no supporting documentation. That means there’s no basis for benefits and the appropriate action is to deny the claim. Delaying or investigating wouldn’t create coverage when the injury occurred after employment ended, and while closing the file might happen after a denial, the proper initial step is to deny based on lack of coverage and documentation.