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Forms In Your Workers’ Comp Case – Don’t Ignore Them

  • Dave Brown, Esquire
  • 12/20/2022

If you have a workers’ compensation claim and have received forms from the insurance company, don’t ignore them. If you do, your benefits could be suspended. Let our PA workers’ compensation lawyer further explain.

Twice a year, the insurance company for your employer can send you three workers’ compensation forms for you to complete, sign, and return: Employee Report of Wages and Physical Condition; Employee Verification of Employment, Self-Employment, or Change in Physical Condition; and Employee Report of Benefits for Offsets.

Whether you are represented by a PA workers’ compensation lawyer or not, you may receive these forms in the mail from the insurance company. It’s important that you fill these forms out completely and get them back to the insurance company. If you are not represented, we recommend that you hire Pearson Koutcher Law. We can assist you in the completion of these forms and represent you in your workers’ comp. claim going forward.

The questions on the first two forms are similar – you are asked first if you have been employed since work injury; if you have been, you are required to list each employer for which you have worked and its address, your dates of employment, and your wages. If you are collecting workers’ comp. benefits, the insurance company is entitled to take a credit based on the post-injury wages you have received. If you are not receiving workers’ comp. benefits but are later awarded benefits by a Judge, likewise the insurance company can reduce your benefits on account of your wages.

If you have not received wages from an employer but have earned money from self-employment – for example, you have made some cash doing painting jobs on the side – you still have to list this income on these forms. The insurance company will be entitled to take a credit based on these earnings.

What happens if you don’t list these earnings on the Employee Report of Wages and Employee Verification of Employment forms? First, it would be illegal because if you are receiving workers’ comp. benefits or have filed a claim for benefits, and you earn money, you are obligated to report this income to the insurance company. Second, if you earn money and fail to report this, and the insurance company finds out, either by conducting surveillance on you or by some other means, it will look bad for you in your case. The mindset of the Judge likely will be – this person was not up front about money that they earned, why should I believe what they say about their injuries?

There is also a question on these two forms, “Has your physical condition (caused by your work injury) changed? This is a somewhat vague question because it’s not entirely clear the point from which you are being asked whether your condition has changed. Is it from the time of your original injury? Or is it from the last time you completed these forms? Or is it from some other point? It’s best to err on the side of caution and respond, “No,” unless something has happened which clearly indicates your condition has changed. For example, if you have gone back to your regular job, that’s an indication your condition has changed for the better and you should answer “Yes.” On the other hand, if your pain has intensified recently, causing you to undergo injections and schedule surgery, you should respond “Yes” and explain the circumstances.

The purpose of the Employee Report of Benefits for Offsets form is so the insurance company can determine if you have any other sources of income that would entitle them to reduce your workers’ comp. benefits. If you have received unemployment benefits, the insurance company is
permitted to take a credit, or offset, on these benefits. The theory is that an injured worker should not be able to “double-dip” and receive workers’ comp. and unemployment benefits for the same time period.

If you started to receive Social Security retirement (also called old age) benefits before your work injury, the insurance company is not entitled to an offset. But if you start to receive Social Security retirement benefits after your injury, then the insurance company may take an offset equal to one-half of your monthly benefit. If you injured yourself at work and then began to receive monthly Social Security retirement benefits of $2,000, the insurance company may reduce your workers’ comp. benefits by $1,000 per month.
You are also asked on this form if you have received severance or pension benefits since you sustained your work injury. The insurance company can take an offset if you have received severance or pension payments from your time-of-injury employer to the extent that these payments are funded by your employer. If you receive a $1,500 pension that is entirely funded by your employer, the insurance company may reduce your workers’ comp. benefits by $1,500 per month.

You have 30 days to return these forms with your signature on each of the forms. If you do not return them within 30 days and you are receiving workers’ comp. benefits, the insurance company can suspend your benefits immediately by filing a Notification of Suspension for your failure to return these forms. The insurance company doesn’t even have to file a petition to cut off your benefits – they can unilaterally suspend your benefits. Your benefits will be reinstated as soon as you return the forms, but you cannot recoup the money that you lost during the time your benefits were suspended.

If you injure yourself at work in Pennsylvania, be aware that the workers’ compensation process is complicated. It is critical that you have an experienced, knowledgeable PA workers’ compensation lawyer on your side. At Pearson Koutcher Law, we specialize in workers’ comp. cases – it’s all we do. We will zealously represent you in your claim and fight the insurance company tooth-and-nail. If the insurance company sends you the forms that we have been discussing, we will help answer any questions you have about these forms and ensure that they are returned on a timely basis so your benefits are not suspended. Don’t delay – call Pearson Koutcher today for a free consultation.