Workers’ Compensation Resources
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What is a Notice of Compensation Payable?
What is a NCP?
A NCP or Notice of Compensation Payable is issued by the Workers’ Compensation Carrier accepting the claim, agreeing to pay wage loss and medical benefits or just medical benefits. This can also be in the form of a Notice of Temporary Compensation Payable, which is only for 90 days.
Notice of Compensation Payable is your ticket and the document you want to receive! In short the Workers’ Compensation Carrier has agreed to cover your work injury. [READ MORE]
What is a Workers’ Comp Denial?
What is a Workers’ Compensation Claim Denial?
Have you received a Denial of your workers’ compensation claim? After you suffer a work injury, you as the injured worker are required to give “Notice” to your employer of your injury as soon as possible but no later than 120 days from the date of the injury or from when you receive a diagnosis from a physician relating it to your work.
After you give “Notice” to your employer, your employer must relay the notice of the work injury to their workers’ compensation carrier. From the date the assigned workers’ compensation adjustor receives the claim, they have twenty-one (21) days to either accept or deny your claim. There are several ways that your claim can be accepted and if a Denial is issued, there must be a reason checked off as to why it is being denied. For purposes of this article, let’s focus on the reasons why your claim could be denied. [READ MORE]
What is a Workers’ Comp Statement of Wages?
Understanding Workers’ Compensation Statement of Wages
A Workers’ Compensation Statement of Wages is a document prepared by the Workers’ Compensation Carrier based on your past earnings, the type of employment (seasonal or non-seasonal), and length of employment. Because of these variables, there are various ways to calculate your wage earnings.
The Statement of Wages (SOW) lists the gross income (this is the amount your earn before taxes are deducted from your pay) that you were receiving before your work injury and also lists the workers’ compensation rate that you will receive from the insurance carrier.
What is an Independent Medical Evaluation?
What is an IME?
An Independent Medical Evaluation, also known as an IME, is scheduled by the Workers’ Compensation Carrier to evaluate the injured workers’ current medical status. This medical exam is performed by a doctor, relevant to your injury, selected by the insurance carrier – which is ‘independent’ from the doctor currently treating you. So, for example, if you have a back injury and are treating with an orthopedic surgeon, you would be sent to an orthopedic surgeon. [READ MORE]
What is a Suspension of Workers’ Compensation Benefits?
Understanding a Suspension of Workers’ Comp Benefits
A Suspension of Workers’ Compensation Benefits is when the Workers’ Compensation Carrier tries to stop your wage loss benefits but not your medical benefits alleging that you are able to return to work in some capacity, whether it be regular, medium, light, or sedentary work according to an Independent Medical Evaluation (IME) report or your own treating Dr’s report.
From the time you begin to receive workers’ compensation wage loss benefits once your claim has been accepted, it is the workers’ compensation adjustor’s job to try and find a way to stop paying you compensation, as it is costing the carrier and your employer premium dollars to have you on workers’ compensation. The workers’ compensation carrier will receive ongoing reports from your treating physicians and if there is an hint that you can return to your job, or the same category of job…ie., desk type work, light, medium, or heavy duty work, that pays the same as your pre-injury work, the carrier will hire an attorney to file a Suspension Petition to try to stop your workers’ compensation wage loss benefits altogether. [READ MORE]
What is a Modification of Workers’ Comp Benefits?
Understanding a Modification of Workers’ Comp Benefits
A Modification of Workers’ Compensation Benefits is when the Workers’ Compensation Carrier will modify or adjust your wage loss benefits based on your ability to return to work based on an offer of return to work, usually in a light or sedentary capacity, as a result of an IME report or your own Dr. indicating your ability to work.
When you are receiving workers’ compensation wage loss benefits as you are totally out of work, the workers’ compensation carrier will eventually send you to an Independent Medical Examiner, a doctor they pay to examine you. This doctor will give an opinion as to whether you are still disabled, fully recovered, or capable of some type of work. For example, if this doctor indicates in his report that you are capable of light duty work, the workers’ compensation carrier will reach out to your employer to see if any light duty work is available for you to return to so that the carrier can limit the amount of compensation you are receiving. [READ MORE]
What is a Termination of Workers’ Comp Benefits?
Termination of Workers’ Compensation Benefits
The first sign that your workers’ compensation wage loss benefits may be in jeopardy is when you receive in the mail a notice for you to attend an Independent Medical Examination (IME). This is a quick one-time examination by a physician of the workers’ compensation carrier’s choice. Keep in mind that the physician is paid directly by the carrier, and in most instances will find a way to side with the workers’ compensation carrier’s position that there is nothing wrong with you regarding your work injury and that you are fully recovered from your work injury.
After a Workers’ Compensation Carrier receives the Independent Medical Examination (IME) report and if it states a full recovery of your work injury, the Workers’ Compensation Carrier will hire an attorney to file a Termination Petition against you, the injured worker, in an attempt to stop all of your wage loss and medical workers’ compensation benefits that you are receiving. [READ MORE]
What is a Utilization Review?
In Pennsylvania workers’ compensation law, a Utilization Review, also referred to as a URO is a process used by the workers’ compensation carriers to challenge the reasonableness and necessity of medical care and treatment provided to the injured worker. In Pennsylvania, when medical treatment is rendered to an injured worker, the medical bill, along with the medical notes and other required documentation is sent to the workers’ compensation carrier for expected payment. If the treatment is related to the work injury, but the carrier believes that the treatment is excessive, not reasonable or necessary, then they will send the relevant medical documentation from the medical provider under review to a Utilization Review Organization to make a determination as to the reasonableness and necessity of the treatment that the treating physician or provider gives to the injured worker. [READ MORE]
*Please note this information is not to be used as legal advice nor by submitting a form on this website or contacting me by phone or email are you entering an attorney-client agreement. This information is purely for information purposes.