Employee Verification Forms Must be Fully Completed to Avoid Suspension of Benefits

When an injured worker in PA is receiving, or attempting to receive, workers’ compensation wage loss benefits, the insurance carrier can send “verification forms” every six months. These forms require the injured worker to certify whether he or she is working, along with a few other questions. If the injured worker does not complete and return the forms, the insurance carrier may suspend payment until the forms are returned.

In McCafferty v. Workers’ Compensation Appeal Board (Trial Technologies, Inc.), the Commonwealth Court of Pennsylvania dealt with two issues regarding the completion and return of these verification forms. First, there was a question whether the forms could be returned by fax. Second, if a form is returned filled out and signed, but not dated, has the form been “returned?”

As to the first question, the Court found that, given today’s level of technology, submission of the verification forms by fax is acceptable. However, with regard to the second issue, the Court was more strict. The form is not “completed” unless it is dated. The date established by the faxed transmission is not necessarily the date the form was filled out. Since the forms can be required only every six months, the insurance carrier is entitled to know when the information was correct. As such, the Court found the verification form must be filled out, signed and dated to discharge the obligation of the injured worker.

Interestingly, the insurance carrier required the form be dated because it believe “a claimant signing the Form LIBC-760 with false information cannot be prosecuted under 18 Pa. C.S. §4904 if the form is signed without a date.” We find this rather humorous, since we have had no less than three occasions when the employer or the insurance adjuster filed an affidavit with a Notification of Suspension, stating our client had returned to work, when, if fact, the client did no such thing. On each occasion, when we brought this act of fraud to the attention of the Workers’ Compensation Judge, it was met with a mere shrug. It would appear insurance fraud is only of interest when it is the injured worker who is being suspected. We think the goal of reducing fraud in the system is noble, but one cannot escape the thought that the application is somewhat biased.

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