Understanding the Notice of Insurer’s Primary Liability Determination (NOPLD)
Workers' compensation is a crucial safety net for employees who suffer from work-related injuries or illnesses. It provides financial support and medical benefits to help them recover and return to work. However, the process of filing a workers' compensation claim can be complex, with various forms and deadlines to navigate. One key form in this process is the Notice of Primary Liability Determination (NOPLD) form, which plays a crucial role in informing stakeholders about the status of a claim. In this article, we'll explore the NOPLD form, its purpose, and how to complete it correctly.
The Purpose of the NOPLD Form
The NOPLD form is used to notify the employee (or their heirs/dependents), the employer, and the department of the insurer's position regarding primary liability on the claim. It provides specific details about whether the claim has been accepted or denied and outlines the employee's rights and responsibilities.
When to File the NOPLD Form
The NOPLD form must be filed whenever a First Report of Injury (FROI) indicates claimed disability extending more than three calendar days. It is crucial to file the form promptly to ensure compliance with statutory requirements. The form must be filed within 14 calendar days from the later of the first day of any disability or the date the employer was aware of the claimed injury and disability.
How to Complete the NOPLD Form
The NOPLD form contains several sections that must be completed accurately. Here's a step-by-step guide on how to complete the form:
Claim Identifying Information: Fill out the boxes in the upper left-hand corner of the form with claim identifying information such as the Worker Identification Number (WID)/Social Security Number (SSN), Date of Injury (DOI), Employee Name, Employer, Insurer, and Claim Number. Ensure that these boxes are fully completed each time the form is filed.
Amended Box: Check the "Amended" box at the top of the form if this is a subsequent filing of the NOPLD form to reflect changes in the insurer's position or changes in the specific details of the claim.
Claim Representative Information: Provide the claim representative's name, phone number, and the date the form is being served on the parties. These details must be fully completed each time the form is filed.
Dates of Lost Time, Notice, and Return to Work: Complete these boxes with the dates of lost time, notice, and initial return to work, and the average weekly wage, if applicable, each time the form is filed.
Boxes 1, 2, and 3: These boxes are used to explain why the form is being filed. Only one box should be checked.
Box 1: Check this box to report acceptance of liability for the claim and payment of wage loss benefits. Provide details of the first payment, including the date, amount, time period covered, compensation rate, and date and frequency of ongoing payments.
Box 2: Check this box to report the acceptance of liability for the claim, but where payment of wage loss benefits is being denied (a partial denial). Check the appropriate box (A, B, or C) to explain why the wage loss benefits are being denied.
Box 3: Check this box to report a denial of primary liability for the claim. Provide a clear reason for the denial and attach medical reports or other documentation used to support the denial.
Penalties for Late Payments or Denials
It's important to note that failure to pay or deny a claim within 14 days can result in penalties. Insurers must adhere to the statutory requirements to avoid penalties and ensure timely processing of claims.
Conclusion
Understanding the NOPLD form is essential for both employees and employers involved in workers' compensation claims. If employee’s don’t understand the NOPLD and the statutory requirements insurers must comply with when completing the NOPLD, they may lose out on benefits they would otherwise be entitled to. The following statutes and rules provide additional information about NOPLD requirements: §176.194, Subd. 3(4) and Subd. 4, 176.221, Subd. 3a, and 176.225, Subd. 1. Also see Minnesota Rules Parts 5220.2570, Subp. 10B, 5220.2540, Subp. 4, 5220.2760, Subp. 1C, and 5220.2770, Subp. 2E.
Frayne Injury Law is a law firm that represents injured employees in work comp cases. A free, no obligation, consultation is available to anyone looking for legal advice.
