By: Keith Landry
DOCUMENT, DOCUMENT, DOCUMENT YOUR CLAIM NOTES AND BE PROACTIVE IN THE PAYMENT (OR NON-PAYMENT) OF BENEFITS
23:1201. Time, place of payment; failure to pay timely; failure to authorize; penalties and attorney fees
23:1201(F)(2) This Subsection shall not apply if the claim is reasonably controverted or if such nonpayment results from conditions over which the employer or insurer had no control.
Recently, there have been some suggestions to eliminate the underlined portion of the aforementioned sentence. Some in the industry noted that the courts have never applied this to their cases. A recent case of mine debunked these assumptions. Facing sixteen penalties and attorney fees, all were denied at the trial court level and only one was reversed by the court of appeal. And the basis of upholding the denial of 15 of the 16 penalties and attorney fees was that the adjuster had no control over the payment of some of the medical and mileage benefits. The adjuster did an excellent job of documenting and keeping track of the voluminous requests for payments. The adjuster faced the convoluted and arduous task of paying numerous medical bills without the proper documentation and keeping track of the mileage and whether the demand for payments were related to the subject injury and documenting why the particular bill or demand for payment did not pertain to the subject accident/injury.
While one may find it easy to simply deny something; in the long run you may be paying for that approach and paying much more than the payment you were obligated to pay. Rather than just deny, document, document, document. Not only document your claim notes to address the basis of denial of payment or untimely payment; but be proactive. Send your decision to the party that is being affected, whether it’s the claimant or medical provider. Especially, if you are requiring more information in order for you to pay the benefit. If the party affected does not provide you with that information, then you have no control over the lack of response. It is highly suggested you send the request more than once. Show some effort on your part that you are following up to remedy the problem.
