Who has the burden of proof when a back-up denial is issued?

When a back-up denial is issued, the burden of proof falls on the insurer. This is because the insurer is responsible for demonstrating that the claim is not valid based on the evidence and information presented. A back-up denial typically occurs when an insurer denies coverage for a work-related injury or condition, and it is the insurer's duty to provide sufficient rationale and evidence to support this decision.

The insurer must show that the claim does not meet the necessary criteria for accepted claims under the law or policy provisions. As the party initiating the denial, the insurer is obligated to justify its position, thereby assuring that all claims are handled fairly and within the guidelines established for workers' compensation.

The other parties, such as the employer, worker, and medical provider, may have roles in providing information or evidence related to the claim, but the primary responsibility for proving the legitimacy of the denial rests with the insurer itself. This establishes a clear accountability framework ensuring that claim denials are substantiated by appropriate documentation and reasoning.