Pennsylvania Notice of Temporary Compensation Payable

There may be no other document in the land of Pennsylvania Workers’ Compensation, except perhaps a “Notice of Ability to Return to Work” or “Employee Verification Forms” that causes so many calls to our office. “Attorney Cardamone, what does this Notice of Temporary Compensation Payable mean? Can the insurer still deny my claim? Why haven’t they made up their mind yet?”

Let’s look at the language in the Pennsylvania Workers’ Compensation Law that governs: (34 Pa.Code Sec. 121.7a) (Section 406.1.(d)(1) of Act- which grants right to file this document if employer is uncertain about whether to accept liability.

This language lays out what must happen when your employer and their carrier are temporarily accepting your work-related injury. Notice that they have a choice- accepting wage loss and medical benefits, or just medical only. The adjustors often fail to send the requisite Statement of Wages and that’s important so that in cases where wage loss is accepted, one can determine if the amount is properly calculated. What’s the remedy for a violation of the Act- a Petition for Penalties. What allows an employer/carrier to temporarily accept a claim- meaning not admitting liability- Section 406 of the PA Work Comp Act.

So what would cause an employer and carrier to temporarily accept a claim and not fully accept it? One reason is the time frame given to investigate- many carriers have trouble getting a lot of medical records in to review in a brief twenty-one day period. Also, some employers want to do their own investigation, to see if there were any witnesses, etc. Filing the Notice of Temporary Compensation Payable gives them the wiggle room to still deny a claim and force a claimant to have to file a Claim Petition which gets litigated before a Work Comp Judge- and which can take up to one year to obtain a Decision if the matter isn’t settled amicably.

So let’s break this down into plain English! If the employer/insurer files a Notice of Temporary Compensation Payable, but then files nothing after that within the 90 day period, then the claim is accepted and the NTCP is treated as a regular Notice of Compensation Payable which designates an accepted claim. This is what you want! It means the employer/insurer has to keep paying the benefits they accepted on the NTCP. If the employer/insurer is going to deny the claim after filing the Notice of Temporary Compensation Payable, it must do so carefully, tracking the specific guidelines above regarding the 5 day period, and filing the Notice Stopping Temporary Compensation and a commensurate Denial.

Accordingly, silence, in terms of receipt of more documents, after receiving a Notice of Temporary Compensation Payable is a good thing. But if you do receive a Notice Stopping and a Denial, call us so we can make sure it was done properly. If it was done properly, the compensation for wage loss and medical stops, and we must file a Claim Petition to get the matter before a Pennsylvania Workers’ Compensation Judge. The statute of limitation for filing a Claim Petition is three years from the date of injury. And remember- the notice requirement is 120 days!

How Does a Notice of Temporary Compensation Payable Work?

Under Section 406 of the Pennsylvania Workers’ Compensation Act, if an employer is uncertain whether a claim is compensable or uncertain of the extent of liability, they can initiate compensation payments without prejudice and without admitting liability pursuant to a Notice of Temporary Compensation Payable (“NTCP”) on a form as prescribed by the Pennsylvania Department of Labor and Industry.

This is a common occurrence as the Pennsylvania Workers’ Compensation Act only gives the employer/insurer 21 day to accept, deny, or temporarily accept a claim- and it can take some time to investigate. The NTCP entitles claimant (the injured worker) to a maximum of ninety days of compensation.

It is important to note that the NTCP does not mean the employer is accepting responsibility for the work-related injury. It can revoke the NTCP by issuing a Notice Stopping and a Notice of Denial during the 90 day period as long as they are filed no later than five days after the last payment. If the employer does not file the Notice within the ninety day period during which temporary compensation is paid or payable, the employer shall be deemed to have admitted liability and the notice of temporary compensation payable shall be converted to a notice of compensation payable. A Notice of Compensation Payable is a document, similar to a NTCP, but which accepts liability for a work injury, whether for medical benefits alone, or medical and wage loss benefits. With the conversion, an NCP isn’t issued- it’s just that the original NTCP converts by operation of law. Therefore, it is important to keep track of the timeline- and it is recommended that an injured worker seek legal guidance as the rules are quite technical in this regard. At Cardamone Law, LLC, we’ve been successful in getting claims converted from a Notice of Temporary Comp Payable to a regular Notice of Compensation Payable, but holding the insurer accountable for breaching the deadline. This makes a huge impact on the value of the case.

If a Notice Stopping is filed, it is very important to get a consult immediately with an Pennsylvania Workmans’ Comp Attorney so that the proper petition can be filed to pursue the benefits in response. Even if a Notice Stopping isn’t filed, you will want your case analyzed to make sure the proper diagnoses are recognized by the insurer/employer. It is very common for the employer/insurer to accept a “strain” or a “contusion” when the injuries are frequently much more serious. The unilateral nature of the NCP or NTCP is frustrating as adjustors don’t often recognize the full extent of injury.

What if the Notice of Temporary Compensation Payable Lists an Injury Description that is Incorrect?

If you look at the upper left hand corner of the document, you will see a heading called “Injury Information“.  Under that, there will be “Body part (s) affected” and “Type of injury” listed. Because it issued unilaterally and within a 21 day period (often, it’s much later than this but let’s be kind and assume the insurer does the right thing- hypothetically speaking), the injury is usually minimized. For example, with a back injury, we typically see “lumbar sprain/strain” as the description of the injury. In many cases, an injured worker finds out, after an MRI or EMG study, that her injury is more severe.  But the insurer or TPA can point to the Notice of Compensation Payable- which is the controlling document until challenged successfully in court, and deny medical bills that cover treatment for diagnoses other than a “sprain” or “strain”.

It is this very dynamic that causes an enormous amount of litigation in Pennsylvania Workers’ Compensation cases. Think about it- if the injury is labeled a “strain”, it will be much easier for a panel doctor or “Independent Medical Examiner” (we all know they are hand picked and not “independent”)  to conclude the injured worker is fully recovered. Likewise, if the employer makes a job offer to an injured worker, under the pretense that the injury was a minor strain or sprain, the judge is more likely to believe the job is within the physical capabilities of the injured worker. Or, if an insurer denies a medical bill for treatment which calls the injury “lumbar radiculopathy“, it will have a leg to stand on if the NCP says the injury was merely a strain or sprain.

It may not seem fair that the employer/insurer/tpa can unilaterally decide what to call the injury. But this is the law in Pennsylvania. In some cases, the insurer will pay for treatment even if the diagnoses do not correlate 100%. But many injured workers get lulled into a false sense of security only to later be confronted with multiple petitions which are all grounded in the notion that the injury was a mere contusion or strain versus something more insidious such as a fracture or herniation.

The decision whether to forge ahead and challenge the description of injury is one that should be discussed with a Philadelphia Workmans’ Comp Attorney.

If You Received a Notice of Temporary Compensation Payable, Call Our Attorneys

If you have received a Notice of Temporary Compensation Payable, or a Notice Stopping, a Notice of Denial, or a Notice of Compensation Payable, fee free to contact Certified Allentown Workman’s Comp Attorney, Michael W. Cardamone 7 days a week at Cardamone Law, LLC at (215) 206-9068 for a free consult. These documents can be confusing and Attorney Cardamone will be happy to explain them and apply them to your situation.