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CHAPTER 123. GENERAL PROVISIONSPART II
Subch. Sec.
A. OFFSET OF UNEMPLOYMENT COMPENSATION,
SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS 123.1
B. IMPAIRMENT RATINGS 123.101
C. QUALIFICATIONS FOR VOCATIONAL EXPERTSAPPROVED BY THE DEPARTMENT 123.201
D. EARNING POWER DETERMINATIONS 123.301
E. COLLECTIVE BARGAINING 123.401
F. EMPLOYE REPORTING AND VERIFICATIONREQUIREMENTS 123.501
G. INFORMAL CONFERENCE 123.601
H. USE OF OPTICALLY SCANNED DOCUMENTS 123.701
I. UNINSURED EMPLOYER GUARANTY FUND
STATEMENT OF POLICY 123.801Authority The provisions of this Chapter 123 issued under sections 401.1 and 435 of the Workers Compensation Act (77 P. S. § § 710 and 991), unless otherwise noted.
Source The provisions of this Chapter 123 adopted January 16, 1998, effective January 17, 1998, 28 Pa.B. 329, unless otherwise noted.
Subchapter A. OFFSET OF UNEMPLOYMENT COMPENSATION, SOCIAL SECURITY (OLD AGE), SEVERANCE AND PENSION BENEFITS
Sec.
123.1. Purpose.
123.2. Definitions.
123.3. Employe report of benefits subject to offset.
123.4. Application of the offset generally.
123.5. Offset for benefits already received.
123.6. Application of offset for Unemployment Compensation (UC) benefits.
123.7. Application of offset for Social Security (old age) benefits.
123.8. Offset for pension benefits generally.
123.9. Application of offset for pension benefits.
123.10. Multiemployer pension fund offsets.
123.11. Application of offset for severance benefits.§ 123.1. Purpose.
This subchapter interprets the provisions of the act which authorize the offset of workers compensation benefits by amounts received in unemployment compensation, Social Security (old age), severance and pension benefits, subsequent to the work-related injury. Offsets shall be dollar-for-dollar and calculated as set forth in § § 123.4123.11. Offsets in excess of the weekly workers compensation rate shall accumulate as a credit toward the future payment of workers compensation benefits.
Notes of Decisions Severance Benefits
Furlough Benefit
Employer was not entitled to a credit against claimants workers compensation award for furlough benefits paid to claimant who was expected to and did, in fact, return to work; furlough benefits are statutorily not considered a severance benefit which is awarded to claimant who separates from employment thus ending the employment relationship with employer. Kelly v. Workers Compensation Appeal Board (U. S. Airways Group), 935 A.2d 68, 71 (Pa. Cmwlth. 2007)
Severance Benefits
The employer may be entitled to an offset for the amount paid to the claimant as severance, which is all taxable benefits paid at separation other than for unused vacation, sick leave or otherwise earned income. Hulmes v. Workers Compensation Appeal Board (Rite Aid Corp.), 811 A.2d 1126 (Pa. Cmwlth. 2002).
§ 123.3. Employee report of benefits subject to offset.
(a) Employees shall report to the insurer amounts received in unemployment compensation, Social Security (old age), severance and pension benefits on form LIBC-756, Employees Report of Benefits. This includes amounts withdrawn or otherwise utilized from pension benefits which are rolled over into an IRA or other similarly restricted account while at the same time the employee is receiving workers compensation benefits.
(b) Form LIBC-756 shall be completed and forwarded to the insurer within 30 days of the employees receipt of any of the benefits specified in subsection (a) or within 30 days of any change in the receipt of the benefits specified in subsection (a), but at least every 6 months.
Cross References This section cited in 34 Pa. Code § 123.1 (relating to purpose); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
§ 123.5. Offset for benefits already received.
(a) If the insurer receives information that the employee has received benefits from one or more of the sources in § 123.3 (relating to employee report of benefits subject to offset) subsequent to the date of injury, the insurer may be entitled to an offset to the workers compensation benefit.
(b) The net amount received by the employee shall be calculated consistent with § § 123.6123.11. The amount received by the employee shall be divided by the weekly workers compensation rate. The result shall be the number of weeks, and fraction thereof, the insurer is entitled to offset against future payments of workers compensation benefits.
(c) The insurer shall notify the employee, the employees counsel, if known, and the Department of the offset as specified in § 123.4(b) (relating to application of the offset generally).
(d) The employee may challenge the offset by filing a petition to review offset with the Department.
Cross References This section cited in 34 Pa. Code § 123.1 (relating to purpose); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
§ 123.7. Application of offset for Social Security (old age) benefits.
(a) Workers compensation benefits otherwise payable shall be offset by 50% of the net amount received in Social Security (old age) benefits. The offset shall only apply to amounts which an employe receives subsequent to the work-related injury. The offset may not apply to Social Security (old age) benefits which commenced prior to the work-related injury and which the employe continues to receive subsequent to the work-related injury.
(b) The offset may not apply to benefits to which an employe may be entitled, but is not receiving.
(c) The offset shall be applied on a weekly basis. To calculate the weekly offset, 50% of the net monthly Social Security (old age) benefit received by the employe shall be divided by 4.34.
Cross References This section cited in 34 Pa. Code § 123.1 (relating to purpose); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
§ 123.8. Offset for pension benefits generally.
(a) Workers compensation benefits otherwise payable shall be offset by the net amount an employe receives in pension benefits to the extent funded by the employer directly liable for the payment of workers compensation.
(b) The pension offset shall apply to amounts received from defined-benefit and defined-contribution plans.
(c) The offset may not apply to pension benefits to which an employe may be entitled, but is not receiving.
(d) In calculating the offset amount for pension benefits, investment income attributable to the employers contribution to the pension plan shall be included on a prorata basis.
Notes of Decisions Defined Benefit Pension
Employer who petitioned for modification of claimants workers compensation benefits by offset against its workers compensation obligation due to claimants receipt of disability pension was entitled to present expert actuarial testimony to establish extent employer funded claimants defined benefit pension; claimants disability benefit was not based on contributions by either the employer or employee but by factors known only at retirement including length of employment, final average salary, and retirement age, and employers contribution could only be determined by an actuarial formula. Pennsylvania State University v. Workers Compensation Appeal Board (Hensal), 911 A.2d 225, 229230 (Pa. Cmwlth. 2006).
Public employer, who filed notice of compensation offset claiming a portion of claimants workers compensation award was subject to an offset due to claimants receipt of a disability pension under a defined benefit plan, was entitled to an offset based on expert actuarial testimony to establish amount of the requested offset where workers compensation judge found that employers actuarial evidence was credible. Department of Public Welfare v. Workers Compensation Appeal Board (Cato), 911 A.2d 241 (Pa. Cmwlth. 2006).
Cross References Nonmunicipal Contributions
In determining the correct calculation of an offset, the Commonwealth was not the employer directly liable for compensation under section 204(a) and third-party contributions to the pension fund should not be used for calculation of a pension setoff. The employer was entitled to a credit only to the extent it directly contributed to the pension. Lower Merion Township v. Workers Compensation Appeal Board, 783 A.2d 878 (Pa. Cmwlth. 2001), appeal denied 568 Pa. 745, 798 A.2d 1294 (Pa. 2002).
Cross References This section cited in 34 Pa. Code § 123.1 (relating to purpose); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
§ 123.11. Application of offset for severance benefits.
(a) Workers compensation benefits otherwise payable shall be offset by amounts an employee receives in severance benefits subsequent to the work-related injury. The offset may not apply to severance benefits to which an employee may be entitled, but is not receiving.
(b) The net amount of any severance benefits shall offset workers compensation benefits on a weekly basis except as provided in subsections (c) and (d).
(c) When the employee receives severance benefits in a lump-sum payment, the net amount received by the employee shall be divided by the weekly workers compensation rate. The result is the number of weeks, and fraction thereof, the insurer may offset against future payments of workers compensation benefits.
(d) When an employee receives a severance benefit in the form of tangible property, the market value of the property, as determined for Federal tax purposes, shall be divided by the weekly workers compensation rate. The result is the number of weeks, and fraction thereof, the insurer may offset against future payments of workers compensation benefits.
Cross References This section cited in 34 Pa. Code § 123.1 (relating to purpose); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
Subchapter B. IMPAIRMENT RATINGS
Sec.
123.101. Purpose.
123.102. IRE requests.
123.103. Physicians.
123.104. Initial IRE; designation of physician by Department.
123.105. Impairment rating determination.§ 123.101. Purpose.
Conflict with Statute
Section 306(a.2)(6) of the Workers Compensation Act (77 P. S. § 511.2(a.2)(6)), requires an insurer to request an impairment rating evaluation (IRE) within 60 days of the expiration of the 104-week period of total disability for purposes of obtaining the automatic relief set forth in 77 P. S. § 511.2(2). An insurers failure to request an IRE within the established time frame does not preclude the insurer from requesting that an employee submit to an IRE at a later time. The results of the IRE will not be self-executing, but rather applicable to a traditional administrative process. Gardner v. Workers Compensation Appeal Board (Genesis Health Ventures), 814 A.2d 884 (Pa. Cmwlth. 2003), 577 Pa. 703, 877 A.2d 59 (2004); affirmed Gardner v. Workers Compensation Appeal Board (Genesis Health Ventures), 888 A.2d 758, 768 (Pa. 2005).
Impairment Rating Evaluations (IREs)
An employer is entitled to the timely request of two Impairment Rating Evaluations (IREs) within a 12 month period without any requirement that employer demonstrate a change in claimants medical condition, permanent impairments, and/or disability. Lewis v. Workers Compensation Appeal Board (Wal-Mart Stores, Inc.), 856 A.2d 313, 318 (Pa.Cmwlth. 2004).
Cross References Employer Cannot Unilaterally Select IRE Physician
Where the goal of an employers request that claimant undergo an Impairment Rating Evaluation (IRE) is to determine claimants degree of impairment, agreement of the parties or the Bureau of Workers Compensation designation are the sole and exclusive avenues for physician selection; employer is not entitled to unilaterally select an IRE physician. Lewis v. W.C.A.B. (Wal-Mart Stores, Inc.), 856 A.2d 313, 319 (Pa.Cmwlth. 2004).
§ 123.105. Impairment rating determination.
(a) When properly requested under § 123.102 (relating to IRE requests), an IRE shall be conducted in all cases and an impairment rating determination must result under the most recent edition of the AMA Guides to the Evaluation of Permanent Impairment.
(b) To ascertain an accurate percentage of the employees whole body impairment, when the evaluating physician determines that the compensable injury incorporates more than one pathology, the evaluating physician may refer the employee to one or more physicians specializing in the specific pathologies which constitute the compensable injury. Any physician chosen by the evaluating physician to assist in ascertaining the percentage of whole body impairment shall possess the qualifications as specified in § 123.103(a) and (b) (relating to physicians). The referring physician remains responsible for determining the whole body impairment rating of the employee.
(c) The physician performing the IRE shall complete Form LIBC-767, Impairment Rating Determination Face Sheet (Face Sheet), which sets forth the impairment rating of the compensable injury. The physician shall attach to the Face Sheet the Report of Medical Evaluation as specified in the AMA Guides to the Evaluation of Permanent Impairment. The Face Sheet and report shall be provided to the employee, employees counsel, if known, insurer and the Department within 30 days from the date of the impairment evaluation.
(d) If the evaluation results in an impairment rating of less than 50%, the employee shall receive benefits partial in character. To adjust the status of the employees benefits from total to partial, the insurer shall provide notice to the employee, the employees counsel, if known, and the Department, on Form LIBC-764, Notice of Change of Workers Compensation Disability Status, of the following:
(1) The evaluation has resulted in an impairment rating of less than 50%.
(2) Sixty days from the date of the notice the employees benefit status shall be adjusted from total to partial.
(3) The adjustment of benefit status does not change the amount of the weekly workers compensation benefit.
(4) An employee may only receive partial disability benefits for a maximum of 500 weeks.
(5) The employee may appeal the adjustment of benefit status to a workers compensation judge by filing a Petition for Review with the Department.
(e) If the evaluation results in an impairment rating that is equal to or greater than 50%, the employee shall be presumed to be totally disabled and shall continue to receive total disability compensation. The presumption of total disability may be rebutted at any time by a demonstration of earning power in accordance with section 306(b)(2) of the act (77 P. S. § 512(2)) or by a subsequent IRE which results in an impairment rating of less than 50%.
(f) At any time during the receipt of 500 weeks of partial disability compensation, the employee may appeal the adjustment of benefit status to a workers compensation judge by filing a Petition for Review.
Notes of Decisions Presumption of Total Disability Can Be Rebutted
Employer may seek to change claimants status based on an independent medical examination and earning power assessment, even where an impairment rating evaluation determined claimant to be at least 50% impaired; an impairment rating of 50% fixes a presumption of total disability status, but it is a presumption that can be rebutted by evidence that the claimant can perform some work. Sign Innovation v. W.C.A.B. (Ayers), 937 A.2d 623, 626, 628 (Pa. Cmwlth. 2007).
Subchapter C. QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT
Sec.
123.201. Purpose.
123.201a. [Reserved].
123.201b. Definitions.
123.202. Qualifications for current vocational experts under Act 57 of 1996.
123.202a. Qualifications for vocational experts under Act 53 of 2003.
123.203. Role of workers compensation judges.
123.204. Conduct of vocational experts.
123.205. Financial interest disclosure.§ 123.201. Purpose.
This subchapter implements and interprets provisions of the act which permit the Department to establish qualifications for vocational experts who will conduct earning power assessment interviews under sections 306(b) and 449 of the act (77 P. S. § § 512 and 1000.5). This subchapter also implements the acts requirements for compliance with the Code of Professional Ethics for Rehabilitation Counselors pertaining to the conduct of expert witnesses and disclosure of financial interest.
Source The provisions of this § 123.201 adopted January 16, 1998, effective January 17, 1998, 28 Pa.B. 329; amended June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804. Immediately preceding text appears at serial pages (309340) to (309341).
§ 123.201a. [Reserved].
Source The provisions of this § 123.201a adopted March 26, 2004, effective March 27, 2004, 33 Pa.B. 1684; reserved June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804. Immediately preceding text appears at serial page (309341).
§ 123.201b. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Financial interestAn interest equated with money or its equivalent, and includes any of the following:(i) A present or former ownership interest in or with the entity or individual conducting the earning power assessment interview.
(ii) A present or former employment relationship with the entity or individual conducting the earning power assessment interview.
(iii) A contractual or referral arrangement that would require or allow the insurer to provide compensation or other consideration based upon the vocational experts opinion or the outcome of the vocational experts earning power assessment interview.
InsurerAn insurer is any of the following:(i) A workers compensation insurance carrier.
(ii) The State Workers Insurance Fund of the Department.
(iii) An employer authorized by the Department to self-insure its workers compensation liability under section 305 of the act (77 P. S. § 501).
(iv) A group of employers authorized by the Department to act as a self-insurance fund under section 802 of the act (77 P. S. § 1036.2).
Source The provisions of this § 123.202 adopted January 16, 1998, effective January 17, 1998, 28 Pa.B. 329; amended July 13, 2001, effective July 14, 2001, 31 Pa.B. 3841; amended June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804. Immediately preceding text appears at serial pages (309341) to (309342).
Cross References The provisions of this § 123.202a adopted June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804.
Cross References The provisions of this § 123.203 adopted January 16, 1998, effective January 17, 1998, 28 Pa.B. 329; amended June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804. Immediately preceding text appears at serial page (309342).
§ 123.204. Conduct of vocational experts.
(a) Before conducting an earning power assessment interview, the vocational expert shall disclose to the employee, in writing, the role and limits of the vocational experts relationship with the employee.
(b) A vocational expert who conducts an earning power assessment interview shall generate a written initial report detailing the experts involvement in the litigation and conclusions from the interview. The initial report need not contain the results or conclusions of any surveys or tests. The vocational expert shall serve a copy of the initial report on the employee and counsel, if known, within 30 days of the date of the interview.
(c) A vocational expert who authors additional written reports, including earning power assessments or labor market surveys, shall simultaneously serve copies of these written reports upon the employee and counsel, if known, when the expert provides the written reports to the insurer or its counsel.
(d) A vocational expert who satisfies the requirements of this section complies with the Code of Professional Ethics for Rehabilitation Counselors pertaining to the conduct of expert witnesses for purposes of section 306(b)(2) of the act (77 P. S. § 512(2)).
Source The provisions of this § 123.204 adopted June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804.
Cross References This section cited in 34 Pa. Code § 123.203 (relating to role of workers compensation judges).
§ 123.205. Financial interest disclosure.
(a) For the purposes of this section, a third-party administrator or another entity that performs services on behalf of an insurer, as specified in section 441(c) of the act (77 P. S. § 997(c)), is an insurer.
(b) Before an insurer refers an employee for an earning power assessment interview, the insurer shall disclose to the employee, in writing, any financial interest the insurer has with the person or entity conducting the earning power assessment interview.
Source The provisions of this § 123.205 adopted June 22, 2007, effective June 23, 2007, 37 Pa.B. 2804.
Cross References This section cited in 34 Pa. Code § 123.203 (relating to role of workers compensation judges).
Subchapter D. EARNING POWER DETERMINATIONS
Sec.
123.301. Employer job offer obligation.
123.302. Evidence of earning power.§ 123.301. Employer job offer obligation.
(a) For claims for injuries suffered on or after June 24, 1996, if a specific job vacancy exists within the usual employment area within this Commonwealth with the liable employer, which the employee is capable of performing, the employer shall offer that job to the employee prior to seeking a modification or suspension of benefits based on earning power.
(b) The employers obligation to offer a specific job vacancy to the employee commences when the insurer provides the notice to the employee required by section 306(b)(3) of the act (77 P. S. § 512(b)(3)) and shall continue for 30 days or until the filing of a Petition for Modification or Suspension, whichever is longer. When an insurer files a Petition for Modification or Suspension which is not based upon a change in medical condition, the employers obligation to offer a specific job vacancy commences at least 30 days prior to the filing of the petition.
(c) The employers duty under subsections (a) and (b) may be satisfied if the employer demonstrates facts which may include the following:
(1) The employee was notified of a job vacancy and failed to respond.
(2) A specific job vacancy was offered to the employee, which the employee refused.
(3) The employer offered a modified job to the employee, which the employee refused.
(4) No job vacancy exists within the usual employment area.
(d) When more than one job which the employee is capable of performing becomes available, the employer maintains the right to select which job will be offered to the employee.
(e) The employers duty under subsections (a) and (b) does not require the employer to hold a job open for a minimum of 30 days. Job offers shall be made consistent with the employers usual business practice. If the making of job offers is controlled by the provisions of a collective bargaining agreement, the offer shall be made consistent with those provisions.
(f) If the employer has presented evidence that no job vacancy exists, the employee may rebut the employers evidence by demonstrating facts which may include the following:
(1) During the period in which the employer has or had a duty to offer a specific job, the employer is or was actively recruiting for a specific job vacancy that the employee is capable of performing.
(2) During the period in which the employer has or had a duty to offer a specific job, the employer posted or announced the existence of a specific job vacancy, that the employee is capable of performing, which the employer intends to fill.
(g) A job may not be considered vacant if the employees ability to fill the position was precluded by any applicable collective bargaining agreement.
Notes of Decisions Ability to Return to Work Form; Issue Waived
Where the Claimant did not raise before the Board the issue of the employers failure to provide and complete Notice of Ability to Return to Work Form, the issue was not preserved for appeal and was not considered by the court. Newhouse v. Workers Compensation Appeal Board (P. J. Dick/Trumbull Corp.), 803 A.2d 828 (Pa. Cmwlth. 2002); appeal denied by 574 Pa. 744, 829 A.2d 311 (2003).
§ 123.302. Evidence of earning power.
For claims for injuries suffered on or after June 24, 1996, an insurer may demonstrate an employees earning power by providing expert opinion evidence relative to the employees capacity to perform a job. The evidence shall include joblistings with agencies of the Department, private job placement agencies and advertisements in the usual employment area within this Commonwealth. Partial disability applies if the employe is able to perform his previous work, or can, considering the employes residual productive skill, education, age and work experience, engage in any other kind of substantial gainful employment in the usual employment area in which the employe lives within this Commonwealth. If the employe does not live within this Commonwealth, the usual employment area where the injury occurred applies.
Subchapter E. COLLECTIVE BARGAINING
Sec.
123.401. Use of ADR systems.
123.402. Forms and filing requirements.
123.403. Effect of creation, continuation and termination of ADR systems.
123.404. Effect and appeal of ADR final determinations.§ 123.401. Use of ADR systems.
CBAs may provide for the use of an ADR system which may include arbitration, mediation and conciliation, for the resolution of claims for work-related injuries.
§ 123.402. Forms and filing requirements.
(a) If the employer and the recognized or certified and exclusive representative of its employes agree to establish an ADR system, a copy of the portion of the CBA which establishes the ADR system shall be provided to the Governors Office of Labor-Management Cooperation in the Department.
(b) The standard forms and filing requirements of the act which reflect the voluntary action or agreement of the parties remain in effect for parties participating in an ADR system under section 450 of the act (77 P. S. § 1000.6). The forms exclusively pertaining to filings before a workers compensation judge are inapplicable to parties participating in an ADR system.
(c) Documents submitted to the Department under this subchapter shall clearly indicate, by notation on the top page of the document, that a section 450 ADR system governs the disposition of the matter.
(d) Final determinations rendered by means of an ADR system shall be documented and a copy of the determination shall be submitted to the parties and to the Department.
§ 123.403. Effect of creation, continuation and termination of ADR
systems.(a) Once established by a CBA, an ADR system shall be the exclusive system for resolving claims for work-related injuries during the existence of the CBA or longer, if the CBA provides for the continued operation of the ADR system at the expiration of the CBA.
(b) When an ADR system governing a work-related injury is no longer in effect, resolution of claims shall be fully subject to the act, including review by a workers compensation judge.
§ 123.404. Effect and appeal of ADR final determinations.
(a) Final determinations rendered under an ADR system are binding and enforceable.
(b) Appeals from determinations rendered under an ADR system are limited to those made under the conditions specified by 42 Pa.C.S. § 7314 (relating to vacating award by court).
Subchapter F. EMPLOYE REPORTING AND VERIFICATION REQUIREMENTS
Sec.
123.501. Reporting requirement.
123.502. Verification.§ 123.501. Reporting requirement.
An insurer shall notify the employe of the employes reporting requirements under sections 204 and 311.1(a) and (d) of the act (77 P. S. § § 71 and 631.1(a) and (d)). In addition, the insurer shall provide the employe with the forms required to fulfill the employes reporting and verification requirements under section 311.1(d) of the act.
§ 123.502. Verification.
(a) Insurers may submit Form LIBC-760, Employee Verification of Employment, Self-employment or Change in Physical Condition, to the employe and employes counsel, if known, to verify, no more than once every 6 months, that the status of the employes entitlement to receive compensation has not changed.
(b) Form LIBC-760 shall be delivered to the employe in person or consistent with section 406 of the act.
(c) The employe shall complete and return form LIBC-760 to the insurer within 30 days of receipt of the form.
(d) If the employe fails to comply with subsection (c), the insurer may suspend payments of wage-loss benefits until Form LIBC-760 is returned by the employe.
(e) To suspend payments of compensation due to the employes failure to comply with subsection (c), the insurer shall provide written notice to the employee, the employees counsel, if known, and the Department, on Form LIBC-762, Notice of Suspension for Failure to Return Form LIBC-760 (Employee Verification of Employment, Self-employment or Change in Physical Condition) of the following:
(1) The workers compensation benefits have been suspended because of the employees failure to return the verification form within the 30-day statutorily prescribed time period.
(2) The workers compensation benefits shall be reinstated by the insurer, effective upon receipt of the completed verification form.
(3) The employee has the right to challenge the suspension of benefits by filing a petition for reinstatement with the Department.
(f) Upon receipt of the completed verification form, the insurer shall reinstate the workers compensation benefits for which the employee is eligible. The insurer shall provide written notice to the employee, employees counsel, if known, and the Department, on Form LIBC-763, Notice of Reinstatement of Workers Compensation Benefits, that the employees workers compensation benefits have been reinstated due to the return of the completed verification form. The notice shall further indicate the date the verification form was received by the insurer and the date of reinstatement of the workers compensation benefits.
(g) Employees are not entitled to payments of workers compensation during periods of noncompliance with subsection (c).
Notes of Decisions Suspension of Benefits
Suspension of benefits for failure to comply with the requirement to file a verification, does not constitute an impermissible automatic supersedeas. Suspension is appropriate; however, benefits should be reinstated upon compliance. Reinstatement requires payment of benefits from the date of reinstatement, and not retroactively to the date of suspension. Farance v. Workers Compensation Appeal Board, 774 A.2d 785 (Pa. Cmwlth. 2001), appeal denied 788 A.2d 380 (Pa. 2001).
Subchapter G. INFORMAL CONFERENCE
Sec.
123.601. Representation of corporation at informal conference.§ 123.601. Representation of corporation at informal conference.
Each party may be represented at the informal conference conducted under section 402.1 of the act (77 P. S. § 711.1), but the employer may only be represented by an attorney at the informal conference if the employee is also represented by an attorney. When the employee is not represented at the informal conference, an employer may be represented by an agent or other representative, other than an attorney, at the informal conference.
Subchapter H. USE OF OPTICALLY SCANNED DOCUMENTS
Sec.
123.701. Use of optically scanned documents.§ 123.701. Use of optically scanned documents.
(a) The Bureau may optically scan original documents, or make other images or paper copies which accurately reproduce the originals, and may dispose of originals so copied.
(b) Copies made under this section, and certified by the custodian of records for the Bureau, are admissible in evidence in a proceeding with the same effect as though they were an original.
Subchapter I. UNINSURED EMPLOYER GUARANTY FUNDSTATEMENT OF POLICY
Sec.
123.801. Uninsured Employer Guaranty Fund.
123.802. Notice to the Uninsured Employer Guaranty Fund.
123.803. Prerequisites for filing claim petition for benefits from Fund.
123.804. Filing of claim petition for benefits from the Fund.
123.805. Rights of Fund.
Source The provisions of this Subchapter I adopted January 19, 2007, effective January 20, 2007, 37 Pa.B. 317, unless otherwise indicated.
§ 123.801. Uninsured Employer Guaranty Fund.
The Department of Labor and Industry (Department) adopts this statement of policy so that all parties will have a clear understanding of their rights and obligations under the act, as amended by Act 147 of 2006 (P. L. 1362, No. 147) (Act 147). This subchapter does not constitute a rule or regulation with the force and effect of law. The Department intends to promulgate regulations for this purpose as soon as practicable.
§ 123.802. Notice to the Uninsured Employer Guaranty Fund.
(a) For purposes of Article XVI of the act (77 P. S. § § ), an injured worker who seeks benefits from the Uninsured Employer Guaranty Fund (Fund) shall notify the Fund of a claim within 45 days from the date upon which the injured worker knew that the employer was uninsured.
(b) Compensation will not be paid from the Fund until notice is given.
(c) Notice to the Fund shall consist of completing and mailing the form designated as Notice of Claim Against Uninsured Employer (Notice) to the Department of Labor and Industry (Department) at the address listed on the form. The Department may reject any incomplete Notice.
(d) The Notice will be deemed filed as of the date of the Notices deposit in the United States Mail, as evidenced by a United States Postal Service postmark, properly addressed, with postage or charges prepaid. If a United States Postal Service Postmark is not present, the date of the Departments actual receipt of the Notice is the filing date.
Cross References This section cited in 34 Pa. Code § 123.803 (relating to prerequisites for filing claim petition for benefits from fund); and 34 Pa. Code § 123.804 (relating to filing of claim petition for benefits from the fund).
§ 123.803. Prerequisites for filing claim petition for benefits from Fund.
(a) Upon the filing of a completed Notice of Claim Against Uninsured Employer (Notice), the Uninsured Employer Guaranty Fund (Fund) will determine whether it will commence making payments.
(b) An injured worker may not seek an award against the Fund unless the worker completes and files the form designated as the Claim Petition for Benefits from the Uninsured Employer Guaranty Fund.
(c) A Claim Petition for Benefits from the Uninsured Employer Guaranty Fund may not be filed until at least 21 days after the injured worker filed the Notice as required in § 123.802 (relating to notice to the Uninsured Employer Guaranty Fund).
(d) A completed Claim Petition for Benefits from the Uninsured Employer Guaranty Fund will be deemed filed upon the later of either of the following:
(1) The date of the petitions deposit in the United States Mail, as evidenced by a United States Postal Service postmark, properly addressed, with postage or charges prepaid; or, if no United States Postal Service Postmark is present, as of the Departments receipt of the petition.
(2) Twenty-one days after the filing of the Notice identified in § 123.802.
(e) The Department may reject any incomplete petition.
§ 123.804. Filing of claim petition for benefits from the Fund.
(a) If an injured worker attempts to file a Claim Petition for Benefits from the Uninsured Employer Guaranty Fund before filing the Notice of Claim Against Uninsured Employer (Notice) required under § 123.802 (relating to notice to the Uninsured Employer Guaranty Fund), the Department will return the petition to the injured worker and instruct the worker to complete a Notice.
(b) A Claim Petition for Workers Compensation (LIBC362) filed against an employer may not act as a claim against the Uninsured Employer Guaranty Fund (Fund) or be deemed notice to the Fund.
(c) An injured worker seeking an award of benefits from the Fund shall file the Claim Petition for Benefits from the Uninsured Employer Guaranty Fund with the Bureau and shall serve the Fund and the alleged employer at the addresses identified on the petition. The Fund is not required to answer a petition which does not conform to this section.
§ 123.805. Rights of Fund.
The Uninsured Employer Guaranty Fund (Fund) is not prejudiced by an agreement, admission or stipulation concerning the compensability, facts or legal conclusions relating to an injury underlying a claim against the Fund unless the Fund is a party to and specifically endorses the agreement, admission or stipulation.
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