If an employer directs you to deny a compensable claim and you know it is compensable, what should you do?

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

Answer: (B)

When a claim is compensable, you must pay the benefits the employee is due, regardless of the employer’s directive to deny. Your role is to base decisions on the law and the facts, not on what the employer tells you. If you know the claim is compensable, delaying or denying benefits can expose you and the plan to penalties and legal risk, and it deprives the employee of timely support for medical treatment and disability payments.

So the correct action is to pay benefits if they are due, and handle any dispute or policy issue through the proper internal channels while keeping accurate documentation. Denying the claim or ignoring the employer’s instruction would not fulfill your duties, and would be inappropriate given the known compensability.