You should deny a claim when there is no documentation to support the injury and the injured worker was terminated before the injury date.

You should deny a claim when there is no documentation to support the injury and the injured worker was terminated before the injury date.

• A. Deny
• B. Accept
• C. Delay and investigate
• D. Close the file

Answer: (A)

In California SIP claims, a claim isn’t compensable if there’s no documentation to prove the injury and the worker wasn’t employed on the date of injury. If the injured worker was terminated before the injury date, there’s no employment relationship at the time the injury would have occurred, so there’s no basis for workers’ compensation coverage. Without documentation (medical reports, incident notes, supervisor statements, etc.) to support that an injury happened in the course of employment, there’s no credible evidence of a work-related injury. Denying the claim is therefore the proper action. Accepting would be inappropriate due to lack of evidence, delaying for investigation isn’t necessary when there’s no employment relationship to validate, and closing the file is a subsequent step that follows a denial rather than the immediate response.

In California SIP claims, a claim isn’t compensable if there’s no documentation to prove the injury and the worker wasn’t employed on the date of injury. If the injured worker was terminated before the injury date, there’s no employment relationship at the time the injury would have occurred, so there’s no basis for workers’ compensation coverage. Without documentation (medical reports, incident notes, supervisor statements, etc.) to support that an injury happened in the course of employment, there’s no credible evidence of a work-related injury. Denying the claim is therefore the proper action. Accepting would be inappropriate due to lack of evidence, delaying for investigation isn’t necessary when there’s no employment relationship to validate, and closing the file is a subsequent step that follows a denial rather than the immediate response.