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There may be no other document in the land of Pennsylvania Workers’ Compensation, except perhaps a “Notice of Ability to Return to Work” or “Employee Verification Forms” that causes so many calls to our office. “Attorney Cardamone, what does this Notice of Temporary Compensation Payable mean? Can the insurer still deny my claim? Why haven’t they made up their mind yet?”
Let’s look at the language in the Pennsylvania Workers’ Compensation Law that governs: (34 Pa.Code Sec. 121.7a) (Section 406.1.(d)(1) of Act- which grants right to file this document if employer is uncertain about whether to accept liability)
(a) If an employer files a Notice of Temporary Compensation Payable, Form LIBC-501, the employer shall do all of the following simultaneously and no later than 21 days from the date the employer had notice or knowledge of the disability: (emphasis added)
(1) Send the Notice of Temporary Compensation Payable, Form LIBC-501, to the employee or the employee’s dependent.
(2) Pay compensation to the employee or to the employee’s dependent.
(3) File the Notice of Temporary Compensation Payable, Form LIBC-501, with the Bureau.
(b) A Statement of Wages, Form LIBC-494A or Statement of Wages, Form LIBC-494C, shall be filed with every Notice of Temporary Compensation Payable, Form LIBC-501, except a Statement of Wages, Form LIBC-494A or Statement of Wages, Form LIBC-494C, may not be filed with a Notice of Temporary Compensation Payable, Form LIBC-501, filed under subsection (d). (notice, it says shall be filed- not may be filed)
(c) To modify a Notice of Temporary Compensation Payable, Form LIBC-501, an employer shall file an amended Notice of Temporary Compensation Payable, Form LIBC-501, with the Bureau during the 90-day temporary compensation payable period. The amended Notice of Temporary Compensation Payable, Form LIBC-501, shall be clearly identified as ‘‘Amended’’ and may have only the insurer’s signature.
(1) A Statement of Wages, Form LIBC-494A, or Statement of Wages, Form LIBC-494C, shall be filed with every amended Notice of Temporary Compensation Payable, Form LIBC-501.
(2) This section does not apply upon conversion of the Notice of Temporary Compensation Payable, Form LIBC-501, to a Notice of Compensation Payable, Form LIBC-495.
(d) In medical only cases, when an employee’s injury has not resulted in lost time from work, an employer may file a Notice of Temporary Compensation Payable, Form LIBC-501.
This language lays out what must happen when your employer and their carrier are temporarily accepting your work-related injury. Notice that they have a choice- accepting wage loss and medical benefits, or just medical only. The adjustors often fail to send the requisite Statement of Wages and that’s important so that in cases where wage loss is accepted, one can determine if the amount is properly calculated. What’s the remedy for a violation of the Act- a Petition for Penalties. What allows an employer/carrier to temporarily accept a claim- meaning not admitting liability- Section 406 of the PA Work Comp Act.
So what would cause an employer and carrier to temporarily accept a claim and not fully accept it? One reason is the time frame given to investigate- many carriers have trouble getting a lot of medical records in to review in a brief twenty-one day period. Also, some employers want to do their own investigation, to see if there were any witnesses, etc. Filing the Notice of Temporary Compensation Payable gives them the wiggle room to still deny a claim and force a claimant to have to file a Claim Petition which gets litigated before a Work Comp Judge- and which can take up to one year to obtain a Decision if the matter isn’t settled amicably.
Here’s the rest of the story, however! Under Section 406.1 of the Pennsylvania Workers’ Compensation Act:
(1) In any instance where an employer is uncertain whether a claim is compensable under this act or is uncertain of the extent of its liability under this act, the employer may initiate compensation payments without prejudice and without admitting liability pursuant to a notice of temporary compensation payable as prescribed by the department.. ..(4) Payments of temporary compensation may continue until such time as the employer decides to controvert the claim.(5)(i) If the employer ceases making payments pursuant to a notice of temporary compensation payable, a notice in the form prescribed by the department shall be sent to the claimant and a copy filed with the department, but in no event shall this notice be sent or filed later than five (5) days after the last payment.(ii) This notice shall advise the claimant, that if the employer is ceasing payment of temporary compensation, that the payment of temporary compensation was not an admission of liability of the employer with respect to the injury subject to the notice of temporary compensation payable, and the employe must file a claim to establish the liability of the employer.
(iii) If the employer ceases making payments pursuant to a notice of temporary compensation payable, after complying with this clause, the employer and employe retain all the rights, defenses and obligations with regard to the claim subject to the notice of temporary compensation payable, and the payment of temporary compensation may not be used to support a claim for compensation.(iv) Payment of temporary compensation shall be considered compensation for purposesof tolling the statute of limitations under section 315.(6) If the employer does not file a notice under paragraph (5) within the ninety-day period during which temporary compensation is paid or payable, the employer shall be deemed to have admitted liability and the notice of temporary compensation payable shall be converted to a notice of compensation payable.
So let’s break this down into plain English! If the employer/insurer files a Notice of Temporary Compensation Payable, but then files nothing after that within the 90 day perod, then the claim is accepted and the NTCP is treated as a regular Notice of Compensation Payable which designates an accepted claim. This is what you want! It means the employer/insurer has to keep paying the benefits they accepted on the NTCP. If the employer/insurer is going to deny the claim after filing the Notice of Temporary Compensation Payable, it must do so carefully, tracking the specific guidelines above regarding the 5 day period, and filing the Notice Stopping Temporary Compensation and a commensurate Denial.
Accordingly, silence, in terms of receipt of more documents, after receiving a Notice of Temporary Compensation Payable is a good thing. But if you do receive a Notice Stopping and a Denial, call us so we can make sure it was done properly. If it was done properly, the compensation for wage loss and medical stops, and we must file a Claim Petition to get the matter before a Pennsylvania Workers’ Compensation Judge. The statute of limitation for filing a Claim Petition is three years from the date of injury. And remember- the notice requirement is 120 days!
Call us 7 days a week for help with any aspect of your Pennsylvania Work Injury. (215) 206-9068 or Email Michael@CardamoneLaw.com