T E MPORARY INSANIT Y IN ACCE PT ING OR DE NYING A CL AIM IN - PowerPoint PPT Presentation

T E MPORARY INSANIT Y IN ACCE PT ING OR DE NYING A CL AIM IN T HE POST - E DI T RANSACT ION E RA Judg e Se e lig : Mo de ra to r with Ha rte Pric e r, Jo se ph Hutte ma nn, E sq uire a nd Ba rb a ra Yo ung , E sq uire

WORK E RS’ COMPE NSAT I ON ACT

NT CP: SE CT ION 406.1(D)(1) OF WC ACT • Ac t 44 o f 1993 c re a te d a no tic e o f te mpo ra ry c o mpe nsa tio n pa ya b le . Se c tio n 406.1(d) o f the Ac t, 77 P.S. 717.1, a dde d b y Ac t 44 o f 1993 a nd furthe r a me nde d b y Ac t 57 o f 1996 sta te s: I n a ny insta nc e whe re a n e mplo ye r is unc e rta in whe the r a c la im is c o mpe nsa b le . . . o r is unc e rta in o f the e xte nt o f its lia b ility . . . the e mplo ye r ma y initia te c o mpe nsa tio n pa yme nts witho ut pre judic e a nd witho ut a dmitting lia b ility pursua nt to a no tic e o f te mpo ra ry c o mpe nsa tio n pa ya b le a s pre sc rib e d b y the de pa rtme nt.

T HE RE QUIRE ME NT S OF ST OPPING A NT CP SE CT ION 406.1(5) (i) If the e mplo ye r c e a se s ma king pa yme nts pursua nt . . . a no tic e in the fo rm pre sc rib e d b y the de pa rtme nt sha ll b e se nt to the c la ima nt a nd a c o py file d with the de pa rtme nt, b ut in no e ve nt sha ll this no tic e b e se nt o r file d la te r tha n five (5) da ys a fte r the la st pa yme nt. (ii) T his no tic e sha ll a dvise the c la ima nt, tha t if the e mplo ye r is c e a sing pa yme nt o f te mpo ra ry c o mpe nsa tio n, tha t the pa yme nt o f te mpo ra ry c o mpe nsa tio n wa s no t a n a dmissio n o f lia b ility o f the e mplo ye r with re spe c t to the injury sub je c t to the no tic e o f te mpo ra ry c o mpe nsa tio n pa ya b le , a nd the e mplo ye e must file a c la im to e sta b lish the lia b ility o f the e mplo ye r. T hus, unde r the Ac t, the e mplo ye r/ insura nc e c a rrie r must file two fo rms a nd se nd the m to the c la ima nt within 5 da ys fro m the da te o f la st pa yme nt o f b e ne fits. T he first fo rm (“a no tic e in the fo rm pre sc rib e d b y the de pa rtme nt”) is the No tic e o f Sto pping o f T e mpo ra ry Co mpe nsa tio n (NST C), a nd the se c o nd is the No tic e o f Co mpe nsa tio n De nia l (NCD).

T HE CONSE QUE NCE S OF I MPROPE RL Y ST OPPI NG NT CP • Se c tio n 406.1(6) pro vide s furthe r c la rity o n the c o nse q ue nc e s o f fa iling to file the a ppro pria te fo rms a nd a dhe re to the time limita tio ns o f the Ac t: • I f the e mplo ye r do e s no t file a no tic e unde r pa ra g ra ph (5) [NST CP] within the nine ty-da y pe rio d during whic h te mpo ra ry c o mpe nsa tio n is pa id o r pa ya b le , the e mplo ye r sha ll b e de e me d to ha ve a dmitte d lia b ility a nd the [NT CP] sha ll b e c o nve rte d to a [NCP]. • T hus, se c tio n 406.1(6) ma nda te s the a uto ma tic c o nve rsio n to a n NCP unle ss a n e mplo ye r/ insura nc e c a rrie r file s b o th the NST C a nd NCD within 5 da ys fro m the da te o f la st pa yme nt, pursua nt to se c tio n 406.1(5), a nd file s the se do c ume nts within 90 da ys fro m the da te o f o nse t o f te mpo ra ry c o mpe nsa tio n

BURE AU RE GUL AT I ONS

§ 121.7A. NOT ICE OF T E MPORARY COMPE NSAT ION PAYABL E • (a ) I f a n e mplo ye r file s a No tic e o f T e mpo ra ry Co mpe nsa tio n Pa ya b le , F o rm L I BC- 501, the e mplo ye r sha ll do a ll o f the fo llo wing simulta ne o usly a nd no la te r tha n 21 da ys fro m the da te the e mplo ye r ha d no tic e o r kno wle dg e o f the disa b ility: (1) Se nd the NT CP fo rm to e mplo ye e ; (2) pa y the c o mpe nsa tio n; (3) F ile the NT CP, F o rm L I BC-501, with the Bure a u. • (b ) A Sta te me nt o f Wa g e s F o rm sha ll b e file d with e ve ry NT CP, F o rm L I BC-501, e xc e pt fo r sub se c tio n (d) (me dic a l o nly).

§ 121.7A. NOT ICE OF T E MPORARY COMPE NSAT ION PAYABL E • (c ) T o mo dify a No tic e o f T e mpo ra ry Co mpe nsa tio n Pa ya b le , F o rm L I BC-501, a n e mplo ye r sha ll file a n a me nde d No tic e o f T e mpo ra ry Co mpe nsa tio n Pa ya b le , F o rm L I BC-501, with the Bure a u during the 90-da y te mpo ra ry c o mpe nsa tio n pa ya b le pe rio d. T he a me nde d No tic e o f T e mpo ra ry Co mpe nsa tio n Pa ya b le , F o rm L I BC-501, sha ll b e c le a rly ide ntifie d a s “Ame nde d” a nd ma y ha ve o nly the insure r's sig na ture . • (1) A Sta te me nt o f Wa g e s, F o rm sha ll b e file d with e ve ry a me nde d NT CP • (2) T his se c tio n do e s no t a pply upo n c o nve rsio n o f the No tic e o f T e mpo ra ry Co mpe nsa tio n Pa ya b le , F o rm L I BC-501, to a No tic e o f Co mpe nsa tio n Pa ya b le , F o rm L I BC-495.

§ 121.7A. NOT ICE OF T E MPORARY COMPE NSAT ION PAYABL E (d) I n me dic a l o nly c a se s, whe n a n e mplo ye e ’ s injury ha s no t re sulte d in lo st time fro m wo rk, a n e mplo ye r ma y file a No tic e o f Co mpe nsa tio n Pa ya b le , F o rm L I BC-495. 34 Pa . Co de § 121.7a (d), 34 PA ADC § 121.7a (d) T he re g ula tio n a utho rize s c re a tio n a nd use o f the Me dic a l Only NT CP Ado pte d Aug . 4, 2007.

§ 121.17 CHANGE IN COMPE NSAT ION (L IBC- 502)R (d) I f te mpo rary c o mpe nsatio n payme nts made unde r §121.7a (re lating to no tic e o f te mpo rary c o mpe nsatio n payab le ) are sto ppe d, the e mplo ye r shall file o ne o f the fo llo wing : (1) A No tic e Sto pping T e mpo ra ry Co mpe nsa tio n, F o rm L I BC-502, a nd a No tic e o f Wo rke rs’ Co mpe nsa tio n De nia l, fo rm L I BC-496, within 5 da ys o f the la st pa yme nt a nd within the 90-da y te mpo ra ry c o mpe nsa tio n pa ya b le pe rio d. (2) A No tic e o f Co mpe nsa tio n Pa ya b le , F o rm L I BC-495. (3) An Ag re e me nt fo r Co mpe nsa tio n fo r Disa b ility o r Pe rma ne nt I njury, F o rm L I BC-336.

CASE L AW

T HE CASE L AW ON NT CP e ye s v. WCAB (Ne w Knight, Inc .) , 793 A.2d 1017 (Pa. Cmwlth. 2002 ) • Ge r • E mplo ye r vio la te d the Ac t b y unila te ra lly c ha ng ing the c o mpe nsa tio n ra te to pa rtia l disa b ility o n a NT CP whe n Cla ima nt re turne d to wo rk a t a wa g e lo ss c o nc luding tha t the c la ima nt must b e pa id a fixe d ra te until the e mplo ye r de c ide s to c o ntro ve rt the c la im. • Co urt a lso c o nc lude d tha t the NT CP ha d no t c o nve rte d to a n NCP b e c a use o f the unila te ra l re duc tio n a s a rg ue d b y Cla ima nt. T his is b e c a use the e mplo ye r file d the NST C a nd NCD within five da ys a fte r pa yme nt o f the la st c o mpe nsa tio n pa yme nt a nd within 90 da ys a fte r the o nse t o f te mpo ra ry c o mpe nsa tio n.

T HE CASE L AW ON NT CP mite ) , 135 A.3d 1153 (Pa. Cmwlth. 2016) Chur c h v. WCAB (L andsc aping & F le ming T e r DOI: 7/ 29/ 04 NT CP file d on 8/ 10/ 04 with AWW of $973.81 and r ate of $649.21 2 nd “Cor r e c te d” NT CP file d also on 8/ 10/ 04 AWW $486.90 with r ate of $345.00 e au Re gs : Co mmo nwe a lth Co urt: “T he Holding: E mploye r may ame nd NT CPs c iting to Bur e mplo ye r did no t vio la te the Ac t whe n it unila te ra lly issue d a “Co rre c te d” NT CP o n Aug ust 10, 2004 tha t pa id the c la ima nt a lo we r c o mpe nsa tio n ra te b a se d upo n a lo we r pre -injury [AWW]. T his me a ns . . .a T NCP ma y b e unila te ra lly a me nde d to re fle c t the lo we r ra te during the 90-da y pe rio d a nd the la st T NCP in e ffe c t a t the e xpira tio n o f the 90 da ys will b e the do c ume nt c o nve rte d to b e c o me the NCP.

CHURCH V. WCAB Holding: E mploye r doe s not have to file a NST CP for e ac h NT CP it file s dur ing the 90 days if it c ontinue s paying te mpor ar y c ompe nsation. Co mmo nwe a lth Co urt: “ He re , the 1st NT CP wa s pro pe rly a me nde d a nd the re wa s no c o nve rsio n o f NT CP to NCP. Ac c o rding ly, Cla ima nt's c o nte ntio n tha t the 1st NT CP c o nve rte d to a NCP a nd the re fo re E mplo ye r wa s o b lig a te d to pa y b e ne fits a t the ra te o f $649.21 pe r we e k fo r a ll pe rio ds o f time whe re Cla ima nt wa s no t wo rking is c o mple te ly witho ut me rit.” Co urt disting uishe s Ge re ye s, “a s it did no t invo lve the a me ndme nt o r c o rre c tio n o f a NT CP, b ut ra the r wa s a c a se in whic h the e mplo ye r unila te ra lly re duc e d the a mo unt o f c o mpe nsa tio n b e ing pa id the e mplo ye e a fte r his re turn to wo rk with a pa rtia l wa g e lo ss.

CASE L AW ON NT CP atio n) , 113 A.3d 861 (Pa. Cmwlth. 2015). Aldr idge v. WCAB (Kmar t Co r po r • DOI : 3/ 7/ 11 • 5/ 9/ 11: NT CP me dic a l o nly: le ft kne e , sho ulde r, a nd ha nd c o ntusio ns • 6/ 13/ 11: Bure a u c o nve rts NT CP me dic a l o nly • 8/ 4/ 11: NT CP inde mnity: “le ft la b rum a nd b ic e p te a r” a nd E mplo ye r a sse rts 90 da ys b e g a n o n July 20 th whe n it le a rne d o f a dditio na l injury • 9/ 15/ 11: NST CP a nd NCD file d