Workers’ Compensation Court Finds That Insurance Company Does Not Need to Issue Forms Notifying Claimant of Stopped Benefits
Facts: Claimant, Lamis Obeid, was employed by Raymour & Flanigan as a home furnishing consultant. On September 14, 2018, Claimant reported that the previous day she had suffered an injury to her coccyx/sacrum when she slipped off a chair while attempting to sit. On October 1, 2018, Employer’s workers’ compensation administrator issued a notice of temporary compensation payable describing Claimant’s work injury as an inflammation of her coccyx/sacrum and providing her with total disability benefits at a rate of $583.28 per week.
On October 17, 2018, the administrator issued a medical-only notice of compensation payable (MONCP). Claimant would go on to file a penalty petition seeking penalties based on a violation of the Workers’ Compensation Act to seek judgment on the pleadings and reinstatement of total temporary disability benefits. The WCJ found that there was no requirement to file a notice stopping temporary compensation (NSTC) payable if, during the temporary period, the employer or insurer decided to issue a notice of compensation payable and concluded that Claimant failed to prove that Employer violated the provisions of the Act or its regulations. Thus, the WCJ dismissed the penalty petition for lack of proof.
Claimant would go onto appeal the ruling to the Workers’ Compensation Appeal Board (WCAB) which would rule in their favor. The WCAB held that because Raymour & Flanigan did not issue a notice stopping temporary compensation and a notice of denial before they issued a MONCP. These forms provide the required notice to the claimant and are in line with the Worker’s Compensation Act. As such, the Board held that the notice of temporary compensation payable converted to a notice of compensation payable by operation of law and the order had violated the act and the restatement of benefits.
Holding by the Commonwealth Court
The Employer would appeal to the Commonwealth Court with the argument that WCAB had committed an error of law by unilaterally ordering the retroactive reinstatement of ongoing disability benefits in violation of the procedural regime established by Section 406.1 of the Act and the Bureau Regulation promulgated thereunder.
The Commonwealth Court found that the Bureau’s regulations requires an Employer who intends to stop temporary payments under an NTCP to file both a Notice Stopping Temporary Compensation and Notice of Denial; or file a Notice of Compensation Payable; or file an Agreement for Compensation. (See 34 Pa. Code §121.17(d)(1)-(3)). The carrier in this instance satisfied the regulatory requirement to accept the claim by filing a MONCP.
The Employer also contended that the Board’s interpretation of the statutory scheme was designed to inform workers that temporary compensation was ending from their employer/carrier and what their rights are was illogical and incorrect as a matter of law. The court would respond through an examination of their holdings in Waldameer Park, Inc. v. WCAB (Morrison), 819 A.2d 164 (Pa. Commw. 2003), and Church v. WCAB (Cook), 135 A.3d 1153 (Pa. Commw. 2016). The Court in Waldameer Park held that the proper course of action is for an Employer to issue an MONCP when they are not contesting liability for medical treatment for an injury. This would allow the Employer to challenge future medical bills or unwarranted wage loss benefits without forcing the claimant to file a petition to preserve their rights. The Court upheld the finding of the Board in Church that issuing a MONCP accepts liability for a claim but suspends wage loss benefits.
The Court in this case ruled that when a MONCP has been issued, the claim is appropriately deemed admitted. And while it does immediately suspend wage loss benefits. The language on the MONCP provides notice to an injured worker as to what their rights are. The logic behind the court’s reasoning was that having to file a Notice Stopping Temporary Compensation followed by a Notice of Denial from the Employer/Carrier would serve primarily to confuse the injured worker and that the injured worker would end up expanding their time and resources to pursue unnecessary litigation.
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