Statistics show that when workers’ compensation claims are reported in a timely manner, there is a better outcome for both the injured worker and the employer. The Pennsylvania Workers’ Compensation Act has several strict timeline limitations that if not adhered to could result in a denial of benefits to an employee or penalties for the employer. It is important that an employee notify their employer of a work injury and an employer report the claim to their carrier as soon as possible.
How many days does an employee have to inform an employer of injury or illness to file a workers’ compensation claim?
Pennsylvania law requires that you inform your employer of an injury or illness within 120 days of the injury. If a claim is not reported within that time frame, an employee could be time barred from filing.
How many days does the employer or insurance carrier have to investigate a claim? How are the days calculated?
The employer or their insurance carrier has 21 days to investigate and accept or deny a claim. The 21 days are calculated from either the date the employer had knowledge of the injury or the initial date the disability began.
Is there a statute from the date of injury for an employee to file a claim petition for benefits?
Yes. It is three years.
When are insurance carriers required to file the first report of injury with the Bureau of Workers’ Compensation?
If an injured worker has missed a full day or work; they must file within 7 days of the first date of disability.
Are medical only claims reviewed for timeliness by the Bureau?
They are not.
If a claim is reported late, can it result in an automatic acceptance?
Yes; if the injured worker is disabled from work and time passes beyond the 21st day.
Is there a waiting period in Pennsylvania?
In the State of Pennsylvania there is a 7 day waiting period. An employee must be off work a total of 14 days to be paid for the first 7 days of disability.
On what day shall payments be made?
Payment shall be made no later than the 21st day. If payment is not made, interest could accrue on all due and unpaid compensation at a rate of 10% per annum.
What forms must be issued in a timely manner with the first indemnity payment?
- Notice of Compensation Payable (NCP) – accepts the claim
- Temporary Notice of Compensation Payable (TNCP) – gives the carrier an additional 90 days in order to investigate the claim.
What must the employee do to receive payment?
In order to received payment for medical treatment the injured employee must treat with a physician listed on the posted panel for the first 90 days of the injury.
How should the employee be informed of the posted panel and the required 90 day treatment window?
There is an Employee Acknowledgement form that the employers should have the employee sign when hired and again after an injury.
If you have questions about the timely reporting of workers’ compensation claims in Pennsylvania or would like a comprehensive review of your risk management, please contact me today.