Two recent cases decided in October, 2015, have significantly changed and impact the way we look at Medical Only Notices of Compensation Payable. These cases will affect not only the manner in which these types of cases are litigated, but also the way a Medical Only Notice of Compensation Payable can be viewed by employers, insurance companies, and self-insured administrators.
The first case decided was Sloan v. WCAB, 1213 and 1399 CD 2014. In this case, the Commonwealth Court held that where an employer issues a Medical Only Notice of Compensation Payable, the claimant will have only three (3) years from the date of injury in which to seek indemnity benefits.
The second case decided by the Commonwealth Court was Alex Ingrassia v. WCAB (Universal Health Services, Inc.), 1212 CD 2014. In this case, decided on October 26, 2015, the Commonwealth Court held that a claimant, in order to establish a loss of earnings resulting from a work related injury, where an employer has issued a Medical Only Notice of Compensation Payable, must file a Claim Petition. Further, the employee, must meet the burden of proving that he/she is disabled as the result of a work injury, through the use of competent medical evidence. The Court noted that simply using the Medical Only Notice of Compensation Payable does not place the claimant into a suspension status, but rather acknowledges the claim. In order to prove their wage loss, the claimant must still continue to meet the necessary requirements under the Claim Petition rationale.
These two cases significantly impact the way we look at Medical Only Notices of Compensation Payable. Prior to the Court’s Decisions, a Medical Only Notice of Compensation Payable was considered to have placed the claimant into a suspension status. In other words, the claimant had a work related injury, but did not have any loss of earnings attributable to that work injury. However, the Commonwealth Court has now held in the Ingrassia case, that this is no longer the case. The Medical Only Notice of Compensation Payable simply acknowledges the existence of injury and the need for ongoing medical treatment. It does not place the claimant in any “special status”, but further requires the claimant to establish that the injury results in disability through the use of competent credible medical evidence. The Court has limited the time frame for filing such a claim, and stated that in order to receive benefits where a Medical Only Notice of Compensation Payable is issued, the claimant must file a Claim Petition.
These cases highlight the importance of proper investigation of each claim and the appropriateness of issuing a Medical Only Notice of Compensation Payable where necessary. Even though there may be no wage loss, a Medical Only Notice of Compensation Payable may be the appropriate document to issue where the claimant needs an extensive period of medical treatment and continued medical follow up. Even though the claimant may be back to work, and there is no wage loss, the issuance of a Medical Only Notice of Compensation Payable will protect the employer from a potential penalty for failing to file appropriate Bureau documents. More importantly, it will also require the claimant to take affirmative steps if they desire to obtain wage loss benefits at some point in time in the future. The claimant will need to meet a specific burden of proof and simply not rely upon the fact that an injury occurred in order to establish the existence of disability.
It must however be kept in mind, that a Medical Only Notice of Compensation Payable is not appropriate in every single case. The use of the Temporary Notice of Compensation Payable and/or Temporary Medical Only Notice of Compensation Payable may be utilized or even a denial and the payment of medical expenses. The choice in issuing the documents would depend upon the severity of the injury and other factors attended to the claim. It should also be kept in mind that a Medical Only Notice of Compensation Payable will require the employer to continue to pay all reasonable, necessary and causally related medical expenses for the life of the claimant, or until such time as the claimant is fully recovered from the effects of any work related injury, even though wage loss may never be relevant. Nevertheless, a Medical Only Notice of Compensation Payable has become a more valued and important tool that can be utilized by employers to successfully manage your claims.