Your employer has specific requirements under the Pennsylvania Workers’ Compensation Act to report your work injury in Pennsylvania. Your employer’s insurance carrier then has specific requirements under the Act as well. It should not surprise you that in some cases employers fail to report the injury to their insurance carrier and/or the insurance carrier fails to fulfill those specific requirements.
Does the injured worker have specific reporting requirements?
Reporting a work-related injury starts with you, the injured worker. You must report the work injury. As we have stated in prior blog articles, notice of injury has specific timelines for the injured worker to report an injury.
First, you have 20 days to report an injury to your employer to be eligible for wage loss benefits back to the first date of disability. If you fail to report the injury to your employer within 20 days, you then have 120 days to report the injury to be eligible for wage loss benefits back to the date you actually reported the injury. Failure to report a work injury within 120 days will forever bar your workers’ compensation claim. Please remember that your employer may have specific workplace rule reporting requirements that you should adhere to.
Second, the easy compliance here is to report your work injury immediately. Failure to do so could jeopardize these statutory deadlines and also could call into question your sincerity and lead to a denial of your claim. This is simple. Report he injury when it happens.
Next, what are the employer and insurance carrier requirements?
The Act requires your employer and the employer’s workers’ compensation carrier to report the work injury within 21 days of the time that you provide notice of injury to your employer. The insurance carrier has four specific options under the Act to report a work-related injury.
First, the insurance carrier could accept the work injury in its entirety. That means the insurance carrier has agreed to pay any wage loss benefits due while you are out of work and to pay medical bills related to the work injury.
Second, the insurance carrier could accept your workers’ compensation claim as a medical claim only. While the insurance carrier agrees to pay medical bills related to the injury, it does not believe you are disabled from work because of the injury. Therefore, the refuse to pay wage loss benefits.
Third, the insurance carrier could temporarily accept your claim for a 90-day period. At any time prior to the expiration of the 90-day period, the insurance carrier could either accept or issue a Stop and then deny your claim.
Fourth, and common, the insurance carrier could simply deny your claim in its entirety. That means they refuse to pay any wage loss or medical benefits. In other words, they are saying to you — prove it.
What happens if insurance carrier fails to report the work-related injury within the statutory requirements?
It is fairly common that the reporting requirements of the insurance carrier are not met and the insurance carrier failed to accept or deny the claim and issue the appropriate Bureau documents. If that is the case, then you should seek experienced workers’ compensation legal representation.
At that point, a Claim Petition for wage loss and/or medical benefits must be filed. When we file the Claim Petition, we will also simultaneously file a Penalty Petition for failure to issue a timely Bureau document. Your case will be assigned to a Workers’ Compensation Judge and the case is then in full workers’ compensation litigation. Should the Judge rule in your favor on the Claim Petition, the Judge then has discretion to award additional penalties for the insurance carrier’s violation of the Act’s reporting requirements.
What should I do next?
Call Mooney Law for an absolutely free consultation. Mooney Law has a long and well-established full workers’ compensation litigation practice. We fully litigate cases and we settle cases when appropriate and in the best interest of our clients. Best interest of our client is the key component here. Call today for a free consultation at 717-200-HELP or 717-632-4656. You may also email our firm to schedule a free consultation at firstname.lastname@example.org. You may also visit our firm website at Mooney4Law.com and complete the Schedule a Consultation form. I sincerely look forward to helping you with your claim.