The Claim Acceptance Letter: What You Need to Know

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Let's say that you are injured at work and you go to the clinic designated by your employer for treatment and to fill out a C-4 Claim for Compensation. Within 30 days after the adjuster receives the C-4, the adjuster must either accept or deny your claim. The adjuster will usually call the employer to get the employer's information about the accident, and to ask the employer whether the employer thinks you have a legitimate claim. If there were witnesses to the accident and the employer doesn't question that your were injured while working, the adjuster then sends you a Notice of Claim Acceptance.

Be sure to check the upper portion of this form where it lists the body parts accepted on the claim. Things can get tricky when the adjuster says "lumbar strain only" when your treating doctor later gets an MRI of your low back and finds a herniated disc. I have several cases right now where the Notice of Claim Acceptance said "lumbar strain only", and after several months of treatment for herniated discs, the adjusters refused to schedule an impairment evaluation to rate the ongoing complaints because any lumbar strain should have been healed by now.

You also need to check that all injured body parts are listed as accepted on the claim. If the Notice of Claim Acceptance only says that your left shoulder is accepted, but you also injured your neck. you need to ask the adjuster in writing to also accept the neck. Request that the adjuster send an Amended Claim Acceptance letter that specifically states that both the shoulder and neck are accepted. Most injured workers neglect to do that, particularly if they are getting physical therapy for both the neck and the shoulder. It may be possible for an attorney to include the neck even after the 70-day appeal time has run on the Notice of Claim Acceptance, but the best way to handle this situation is to write to the adjuster asking the adjuster to make a determination with appeal rights about including the neck injury on the claim. It won't be enough to later complain to a hearings or appeals officer that you verbally told the doctor that your neck hurts too, and the doctor didn't look at your neck when you asked him to do that.

Injured workers usually feel relieved to get a Notice of Claim Acceptance. They rarely read the form carefully to make sure that the adjuster is not trying to limit the scope of the claim to a lesser diagnosis or to only one of several injured body parts.