Claim Petition Needed to Get Wage Loss Benefits from Medical-Only Notice of Compensation Payable
In 2004, the Pennsylvania Bureau of Workers’ Compensation created the medical-only Notice of Compensation Payable (NCP). This addressed a long-standing practice in the insurance industry of using a Notice of Denial (NCD) to accept a claim solely for medical benefits. For years, we have questioned the procedure an injured worker would use to allege a wage loss after the issuance of a medical-only NCP. To be safe, many of us filed both a Claim Petition and a Petition for Reinstatement in such a situation. This issue has now been clarified by the Commonwealth Court of Pennsylvania.
In the case of Ingrassia v. Workers’ Compensation Appeal Board (Universal Health Services, Inc.), the injured worker was involved in a motor vehicle accident while performing his work duties. A medical-only NCP was issued, accepting a neck and back strain. The injured worker believed his injuries were more significant, and that the work injury caused him to be disabled from performing his job. A Claim Petition was filed, then amended by the injured worker to operate as a Petition for Reinstatement (the burden of proof is much less for a Petition for Reinstatement, so that would be the desired petition for an injured worker to use in this situation).
After hearing the evidence, the Workers’ Compensation Judge (WCJ) concluded that the work injury was more extensive than already accepted (so the diagnosis of left ulnar neuropathy was added), but that the injured worker failed to prove that he was disabled by the injuries. Upon appeal, the Workers’ Compensation Appeal Board (WCAB) affirmed.
The Commonwealth Court of Pennsylvania first examined the appropriate burden of proof in this situation. It had been the belief of many of us, as attorneys who represent injured workers in PA, that a medical-only NCP is akin to a suspension status, such that one would only need a Petition for Reinstatement to prevail (and, this would not even technically require a medical opinion – one need only show the disability recurred through no fault of the injured worker). Unfortunately, this argument was soundly rejected by The Court:
“Because Claimant did not establish a loss of earning capacity
resulting from the work injury accepted by Employer, there were no disability
benefits to suspend or to reinstate. In short, Claimant’s case has not ‘advanced
procedurally or in substance to the suspension/reinstatement stage.’”
As such, The Court concluded that the appropriate Petition to be used here is the Claim Petition, meaning that the injured worker bears the more demanding burden of proof to show that the injury is related to work and has caused the disability. Interestingly, The Court did vacate the decision of the WCAB, and remand back to the WCJ, due to some inconsistencies in the findings of fact made by the WCJ (while the WCJ is the ultimate finder of fact, those findings must be supported by, and consistent with, the evidence of record). The reasons for vacating and remanding are too specific to the facts, however, to be worth further discussion here.