What happens if you injure yourself at work and your employer just “blows it off” and doesn’t submit your claim to its insurance company? Or what happens if your employer submits the claim, but the insurance company does not file any documents, accepting or denying the claim? Can they get away with that? We’re here to tell you.
Pennsylvania law provides that an employer and its workers’ compensation insurance company have 21 days from the time an employee reports a work injury to accept or deny a claim. The insurance company has the option to:
The insurance company can also issue a Temporary Notice of Compensation Payable for both wage loss and medical benefits, or just medical benefits. The insurance company will then have 90 days to decide whether to continue accepting your claim or change its mind and deny the entire claim or the wage loss portion of the claim.
It happens often. In that case, you’ll need to hire a PA workers’ compensation lawyer to file a Claim Petition with the Bureau of Workers’ Compensation, seeking wage loss and medical benefits. Your case will then be assigned to a Workers’ Compensation Judge. If you hire Pearson Koutcher Law, we will file a Claim Petition and a Penalty Petition if the insurance company failed to file documentation within 21 days, requesting a 50% penalty on the wage loss benefits that you are seeking.
The Judge assigned to your case will hold a series of hearings and receive evidence, then make a ruling on your Claim Petition and Penalty Petition. With regard to the Claim Petition, the Judge will determine whether: 1) you sustained injuries in the course of your employment; 2) these injuries rendered you disabled from performing your job; and 3) you have fully recovered from your injuries. The Judge may also decide other issues, such as whether you are able to perform a light-duty position that the employer made available to you following your injury.
In ruling on your Penalty Petition, the Judge will decide whether your employer and its insurance company violated the Pennsylvania’s Workers’ Compensation Act. Because the Act requires that the insurance company file documentation accepting or denying your claim within 21 days of being notified of your injury, a violation occurs if the documentation is issued after the 21-day period. That there has been a violation does not necessarily mean, however, the Judge will award you a penalty. If the insurance company filed documentation a week late, the Judge may consider that a minor violation and decline to award a penalty. But if the insurance company waited for three months to file either an NCD or NCP-med. only (if it filed an NCP, you would be getting paid and wouldn’t need to file a Claim Petition) or never filed any documentation, the Judge may consider this a blatant violation of the Act and award you a penalty.
The Judge’s decision to award or not award you a penalty also hinges on whether the Judge finds your testimony credible and grants your Claim Petition. If the Judge does not find you credible and concludes that either you weren’t injured in the course of your employment or only suffered a minor injury that did not disable you, you will not be awarded any penalty. Under these circumstances, the Judge’s mindset probably would be that you weren’t entitled to workers’ compensation benefits anyway so even if the insurance company filed documentation late or not at all, despite the legal violation, the Judge will either deny the Penalty Petition or grant the Penalty Petition but not award you any penalty since you were not entitled to any wage loss benefits.
On the flip side, if the Judge accepts your testimony as credible in its entirety and finds that you sustained injuries that rendered you disabled, the Judge may be inclined to award you a penalty, depending on if and when the documentation was filed. If the insurance company filed two weeks late, maybe the Judge will impose a 10% penalty on the employer based on the wage loss benefits that you are due. If the documentation was filed three months late or not at all, the penalty may be closer to the maximum of 50%. The Judge has the complete discretion to award no penalty whatsoever or a percentage up to 50%.
The upshot of all this is that an employer and insurance company put themselves on shaky ground by ignoring a workers’ compensation claim. Any prudent employer will promptly submit the claim to its insurance company, which will then file documentation within 21 days. Otherwise, there is the risk that a Judge will slap them with a penalty.
Some words of wisdom to you on the subject of notification of a work injury: Tell your employer about a work injury right away, even if it is minor. The longer you wait, the more skeptical your employer, the insurance company, and possibly the Judge may be about your claim.
Here’s the most important advice we’re going to give you: If you injure yourself at work, after notifying your employer, please contact Pearson Koutcher Law. We are dedicated to representing injured workers – that’s all we do. Each of our PA workers’ compensation lawyers has represented injured workers for more than 25 years and is therefore very well-versed on how to handle a workers’ compensation case. Please call us for a free consultation today, and let us put our experience and skill to work for you.