A twenty year old employee is injured at work but does not report it as required by work procedures. The employer finds out, investigates and determines it is not work related and denies it but does not report it to the TPA. The TPA gets a Notice to Pay Benefits from the WCAB. What should the TPA do?

• A. Deny benefits.
• B. Report to the WCAB.
• C. Report to the administrative director.
• D. Pay benefits in accordance with the Labor Code.

Answer: (B)

When a Notice to Pay Benefits comes from the Workers’ Compensation Appeals Board, the next step for the Third-Party Administrator is to report to the WCAB. This notice places the claim in the Board’s oversight and signals that benefits may be due or need to be coordinated. The TPA’s responsibility is to acknowledge receipt of the notice and communicate with the WCAB about the claim’s status, the employer’s actions, and the plan to comply with the Board’s directive. This keeps the process aligned with the Board’s procedures and timelines.

Denying benefits would ignore the Board’s notice. Reporting to the administrative director isn’t the proper channel for this particular action, and paying benefits without first aligning with the Board’s directive could bypass required procedures. Reporting to the WCAB ensures the case remains correctly tracked and managed under California workers’ compensation rules.