An employer calls and directs you to deny a claim you know is compensable. You should:

• A. Ignore the employer
• B. Deny the claim
• C. Deny the claim based on information from the employer
• D. Pay benefits if they are due

Answer: (D)

When a claim is compensable, the obligation to provide benefits rests on the law and the facts of the case, not on what the employer tells you to do. If you determine or have strong evidence that a claim is compensable, you must pay the benefits that are due under the workers’ compensation system, even if the employer asks you to deny it. The employer cannot override the employee’s rights or the plan’s duty to provide medical treatment, temporary disability, and other benefits as appropriate.

Handle the claim according to the evidence: authorize needed medical care, make disability payments if warranted, and continue the investigation to confirm all details. Denying a compensable claim or buying into an employer’s directive would undermine the employee’s rights and could expose the plan to penalties or liability. The correct action is to pay benefits that are due and proceed with proper adjudication based on medical and factual findings.