Notice Of Controversion Memo Of Denial Of Workers Compensation {11 DCWC}

11 DCWC - NOTICE OF CONTROVERSION MEMO OF DENIAL OF WORKER’S COMPENSATION. This form is issued by the District of Columbia Government Office of Workers' Compensation. It is used by an employer or insurer to formally deny a worker’s compensation claim filed by an employee. The form includes essential identifying details such as the employee’s and employer’s names and addresses, date of the accident, and the date the first report was received. The employer or insurer must specify the reason(s) for denying benefits from a list of potential grounds, such as lack of an employment relationship, no causal connection between the injury and the employment, insufficient notice of injury by the employee, contested continuing disability, lack of jurisdiction under D.C. law, or other specified reasons. The form also notifies the employee of their right to challenge the denial by requesting a hearing using Form No. 20, or by participating in an informal conference. www.FormsWorkflow.com