The initial report of a possible work injury must be handled carefully by the employer and/or its insurance carrier in order to avoid a scenario where an “accepted” claim should have been “denied” and vice versa. For decades, the employer/carrier was able to review claim information, complete a First Report of Injury, and make the appropriate determination as to whether to accept or deny a claim. Information gathering regarding the incident that caused the alleged injury, pre-existing treatment/conditions, and review of initial medical reports regarding the occurrence of the alleged injury was critical to making the right call with regard to formally accepting or denying a claim. Employers and insurers would utilize the results of the initial investigation to make a determination whether to accept or deny the claim – with no review/input or influence by the PA Bureau of Workers’ Compensation.
Effective January 28, 2017, that process of initial claim review, and issuance of the appropriate “Bureau document,” has changed dramatically. Employers and Workers’ Compensation insurance carriers are no longer permitted to file the Bureau document that determines whether a claim is accepted or denied.
Per the attached IMPORTANT NOTICE TO COUNSEL that has been provided by Workers’ Compensation Judges to attorneys, beginning earlier this month (February, 2017), the filing of a formal acceptance or denial of a new claim is no longer in the hands of the employer or carrier, but rather left to the Bureau of Workers’ Compensation – which “automatically generates” the appropriate form, based strictly on the information contained within the First Report of Injury.
Via review of the information contained within the First Report of Injury, the Bureau will make the decision whether to issue a Notice of Compensation Payable (“NCP”)(accepting the claim), a Temporary Notice of Compensation Payable (“TNCP”)(a 90 day acceptance with the right to revoke within that timeframe), a “medical only” Notice of Compensation Payable (“MO-NCP”)(accepting a claim where there is no lost time, but there is medical exposure), or a Notice of Denial (“NCD”)(denying the claim). As noted on the IMPORTANT NOTICE, “You should become familiar with the policy…since it will play a role in litigation of many claims” – which could be the understatement of this new year. The acceptance, denial or limited acceptance of a claim is one of the most critical aspects of managing new claims, and/or preparing for, or avoiding, Workers’ Comp litigation.
Finally, it should be noted that – this new procedure does not necessarily create a “second set of eyes,” reviewing claims and making decisions regarding compensability. As noted above, the Bureau document chosen and filed will be based on the information provided on the First Report of Injury. As this new process is implemented, we certainly expect some issues to arise, including a possible increase in the number of claims going into litigation.
The “statement of policy” and additional information regarding this change is available via this link: http://www.pabulletin.com/secure/data/vol47/47-4/149.html
