Nationwide among the claims and risk management community, Pennsylvania is known as being a forms-intensive state. But the Commonwealth just became slightly less forms-intensive with the recent Pennsylvania Supreme Court decision upholding a Workers’ Compensation Judge’s Decision allowing an employer to pull a TNCP and file a medical-only NCP – but without issuing a Notice Stopping Compensation and subsequent Notice of Denial. Our Supreme Court’s common-sense denial of a claimant’s appeal makes claims handling much easier and more streamlined.
In Raymour & Flanigan v. WCAB (Obeid), 264 A.3d 817 (Pa. Commw. 2021), the Commonwealth Court held that an employer, which at first files an TNCP, and thereafter, within the initial 90-day period, acts to limit its liability and files a presumably superseding Medical-Only NCP, need not, at the same time, file a Notice Stopping Compensation and a Denial. More specifically, in its holding, the Court ruled that the Workers' Compensation Appeal Board (WCAB) erred in applying Workers' Compensation Act § 406.1(d)(5), reinstating a claimant's indemnity benefits, because it was inapplicable as the employer had filed a medical-only notice of compensation payable. The Court further explained that the employer was also not required to file a notice stopping temporary compensation payable and a notice of compensation denial, pursuant to 34 Pa. Code § 121.17(d)(1)-(3), which properly required that the employer either comply with § 406.1(d)(5) or file a notice of compensation payable, of which a medical-only notice was one variety.
The Court agreed with the employer’s argument and appeal of the WCAB decision. The Court wrote that that in the case where a medical-only notice of compensation payable is filed, the first statement on the original TNCP (that the document does not constitute an admission of liability), becomes legally incorrect. This is because the employer is now acknowledging the injury. Further, the second statement (that an employee must file a claim to establish liability) was equally no longer true. Ultimately the Court ruled that, in this scenario, the claimant must file a Reinstatement Petition, not a Claim Petition.
Comment: In a jurisdiction that is so reliant on the filing of correct petitions and forms, this is a rare decision which heavily favors employers. So often do we see situations where employers are penalized, or at the very least, must face frivolous Penalty Petitions for the failure to issue the appropriate bureau documents. Likewise, employers have had to reinstate benefits automatically for failure to utilize appropriate forms. The decision by the Supreme Court to deny the claimant’s appeal in the present case confirms the employer did nothing wrong in the present case. It keeps an otherwise straightforward and clean situation from getting overly messy with the issuance of multiple unnecessary forms. Cases like these are, hopefully, a step in the right direction for common sense methods and outcomes, which ultimately benefit both employees and employers, when deciding to accept or deny a claim, and consistently moving away from an already complicated system.