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The Notice of Insurer's Primary Liability Determination (NOPLD) form is completed by the insurer, self-insured employer or third-party administrator to notify the claimant (or heirs and dependents of the claimant) and the Department of Labor and Industry (DLI) of the insurer's position regarding primary liability on the claim, with specific details of the acceptance or denial. (It is important to note this form could be completed several different times on the same claim to reflect a change in the insurer's position or a change in the specific details of the claim. These subsequent filings of the form would be considered amended NOPLD forms.)

This form reports the acceptance of an injury or death claim with wage-loss benefits commencing, including:

  • temporary total disability (TTD) (or full-wage plan);

  • temporary partial disability (TPD);

  • permanent total disability (PTD); and

  • dependency (DEP) or fatality with no dependents.

It also reports:

  • the acceptance of an injury with advisement that payment of TPD benefits will commence in the future, upon your receipt of wage-loss information (an amended NOPLD form must be filed when payment is made or upon change to a nonwage-loss payment claim);

  • the acceptance of medical liability on a claim, but denial of wage-loss liability; and

  • a denial of primary liability of an injury or death claim.

DLI uses the information supplied on the form to review for timely and accurate compliance with the statutes and rules, for statistical data and to publish a legislatively mandated annual report about the promptness of insurers first actions on claims.

Accepting primary liability

When this form is completed to accept primary liability, the first payment must be made within 14 days of the first day of claimed lost time or the date on which the employer first received notice of the claimed lost time, whichever is later. This form must be filed whenever the following occurs:

  • liability is accepted with an initial wage-loss payment;

  • liability is accepted for wage-loss benefits and the employer has a full-wage plan;

  • liability is accepted for temporary partial disability benefits and payment will be made in the future, upon receipt of wage-loss information; or

  • liability is accepted on a fatality claim.

Denying primary liability

When this form is completed to deny primary liability, this form must be filed with DLI within 14 days of the first day of the disability or the date the employer was aware of the disability, whichever is later, when the denial of primary liability is determined or partial denial of liability for the initial claimed disability is determined.

This form is sent to:

  • the claimant, heirs and dependents;

  • the attorney for the claimant, heirs and dependents (if represented);

  • the DLI Workers' Compensation Division; and

  • the employer.

A copy should be kept for your files as well.

For more information, see: