The Notice of Compensation Payable (the “NCP”) is the single most important document is the entire Pennsylvania (PA) Workers Compensation system because:
1. No claim is officially recognized, absent a Judge’s decision, unless and until an NCP is issued. An injured worker could have a WC Claim number and the workers’ compensation carrier may be paying for all medical treatment for the injury; however, if three years goes by and the Notice of Compensation has not been issued, the injured worker may be out of luck with no legal recourse. Generally, payment of medical expenses does NOT admit there was a work injury! No NCP, means no official claim, which means no legal protection for the injured worker.
2. The Notice of Compensation Payable contains a Description of Injury filled out by the insurance adjuster early in that claim. Insurance Adjusters deliberately fill out the description of injury to benefit the insurance company by limiting liability. Example: Jane Smith is injured on January 1, 2012. The injury is to her entire left upper extremity as shown in the medical records. The WC Insurance Adjuster fills out the Notice of Compensation Payable Description of Injury as “ Wrist/elbow strain” Jane is getting paid workers comp and her medical bills are being paid. Jane therefore doesn’t pay any attention to the misleading Description of Injury. Four years later, Jane needs serious surgery repair the rotator cuff tear to her shoulder and will miss months of work. All the doctors agree that the shoulder injury results from the work accident. Jane may be out of luck since the Description of Injury in the Notice of Compensation only recognized a wrist injury. The Insurance Company will deny that they have to pay for the shoulder surgery or for lost wages while she recovers form the surgery and attends physical therapy. At best, Jane may have to go through a year of litigation. If she waits too long, she has no recourse no matter that the surgery is related to the work injury.
QUESTION: You mean to tell me that even though I have been paid Workers Comp and my doctors have had their bills paid, I may not have legal protection through WC because one piece of paper wasn’t filled out correctly? ANSWER: Yes, it happens all the time. This type of court case occurs every day. The above fact situation is exactly what this lawyer was arguing in WC Court in Lancaster, PA yesterday. I will quote what the WC defense attorney told me: “ Dr X ( the defense medical expert for hire) is going to say that the shoulder injury doesn’t result from the work injury. I don’t care what the treating doctor thinks, I can make it really rough for your client. And by the way, her job is going to try and fire her despite her 25 years service because she is missing time from work for an injury not recognized by the NCP.”
There are three different types of this important Notice of Compensation Payable form:
1. The Notice of Compensation Payable: This is issued by the workers’ comp insurance company within 21 days of the first day off work unless the claim is denied in writing. An insurance company violates the law if they don’t accept or deny a claim within 21 days of the first day of disability. REMEMBER that a claim is ONLY accepted through means of a Notice of Compensation Payable although in a minority of cases, a carrier will use an Agreement for Compensation form. An NCP is an open ended document; WC must be paid until the case is closed by Judge’s Order, or Notice Stopping Compensation based on a Return to Work, by Supplemental Agreement signed by the injured worker, or by a settlement approved by a workers’ compensation judge.
2. A Temporary Notice of Compensation Payable: The accepts liability for 90 days after which time the document converts into a regular NCP or is denied. If PROPERLY denied, the case has never been accepted and the injured worker must file a Claim Petition within 3 years of the date of injury.
3. A Medical-Only Notice of Compensation Payable. This means that the insurance company is ONLY agreeing to pay medical bills “on their face related to the Description of Injury on the Notice of Compensation Payable”. If the injured workers wants wage loss workers comp benefits, a Petition must be filed within three years of the date of injury unless an amended NCP is issued.
Here are the steps injured workers in Pennsylvania WC cases must take to protect their rights:
1. If no NCP is issued, a Claim Petition must be filed within three years of the date of injury
2. If a TNCP is issued, the injured worker should get appropriate legal advice; there are complicated rules which apply here. Any Denial must follow certain rules, for example, a Denial must be issued within 5 days of the last WC check issued. A Petition for Reinstatement or Claim Petition may need to be filed.
3. The Description of Injury contained in any Notice of Compensation should a) describe all body parts injured and b) contain the correct medical diagnosis. For example, “ruptured cervical disc at C5/C6” is better than “neck strain” if the injured worker wants neck surgery and the wage loss/disability therefrom paid for by WC. As a general rule of thumb, a Petition to Review the Description of Injury should be filed within three years of the Date of Injury. This time limit may not apply in all cases.
If you find any of this confusing, give us a call and we will advise you at no cost. The law firm of Calhoon & Associates represents injured workers Disability throughout Pennsylvania, including but not limited to, Altoona, Harrisburg, Pottsville, Allentown, Reading, Bloomsburg, Easton, Bethlehem, Norristown, Bristol, Williamsport, State College, Wilkes-Barre, Scranton, Lancaster, Waynesboro, York and all cities in Bucks County, Chester County, Columbia County, Dauphin County, Delaware County, Lackawanna County, Lancaster County, Lebanon County, Lehigh County, Luzerne County, Lycoming County, Montgomery County, Monroe County, Montour County, Northampton County, Northumberland County, Philadelphia County, Pike County, Schuylkill County, Wyoming County and York County, PA. Our offices are located at 2411 North Front Street, Harrisburg, PA and we can arrange for meeting locations at law offices throughout the State.
Calhoon & Associates
2411 North Front Street
Harrisburg, PA 17110