An employee is injured at work but does not report as required by procedures. The employer investigates and denies the claim, but does not report to the TPA. The TPA later receives 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 the WCAB issues a Notice to Pay Benefits, the claim has moved into a stage where the Board is directing action on benefits and dispute resolution. The third-party administrator, acting for the employer, must engage with the Board to address the claim’s status and the facts surrounding the injury, especially since the employee wasn’t reported promptly and the denial wasn’t properly communicated to the TPA. Reporting to the WCAB ensures the Board has the correct information, can enforce the proper procedures, and can determine whether benefits should be paid, whether a hearing is needed, or if penalties or other corrective steps apply. The TPA should not unilaterally deny, pay without Board direction, or escalate the matter to the administrative director as the primary action in this scenario. Providing a timely report to the WCAB keeps the claim on track within the Board’s dispute-resolution process and facilitates proper handling.