Form Focus: Vt. Form 2 – Denial of Workers’ Compensation Benefits by Employer or Carrier

Montpelier, VT (WorkersCompensation.com) -- In Vermont, when denying a claim, an employer or carrier must file a Form 2, and notice must be sent to the employee and the Department of Labor. The employer or carrier must indicate the reason for denial and documents supporting that reason by indicating at least one of the following:

[ ] Medical bill not related to accepted injury (please specify date of bill).

[ ] No injury arising out of and in the course of employment.

[ ] No indemnity due.

[ ] No causal relationship between injury and disability.

[ ] Medical release (Form 7) not returned by claimant.

[ ] Treatment is not reasonable, necessary or related to the injury,

[ ] Preauthorization of medical treatment.

[ ] Other (specify the reason)

Appeals

A worker may appeal the denial by answering whether they:

+ Notified the employer or supervisor of the injury or illness.

+ Identify who they reported the injury to and on what date.

Need forms? You need Simply Forms

Challenging the denial also requires a worker to:

+ Explain how the injury or illness occurred.

+ Indicate if time was lost from work due to the injury or illness.

+ List, if they have returned to work, what date they returned.

The documents a worker can submit in support of an appeal include:

[ ] Treatment notes from each office visit with any medical provider.

[ ] Emergency room records.

[ ] Radiology reports (not films).

[ ] Chiropractic records.

[ ] Physical therapy notes.

[ ] Written clarification from the treating providers as to whether they feel the condition is work-related
(DOL strongly recommends this documentation).

Share This Article: