NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
Notice Issue- Section 311 Business owned by Claimant.
Erie Insurance Property & Casualty v. Heater, No. 148 C.D. (2023) (Pa Cwmlth -05/29/2024)
Where the Claimant is both the injured employee and employer/sole proprietor, the employer to whom the Claimant must provide notice of a work related injury for compliance with Section 311 of the PA Workers Compensation Act, is the insurance company that bears the ultimate responsibility for the claim, which allows the insurer to complete a prompt and thorough investigation into the alleged work injury which would normally be performed by the employer. Claimant, David Heater, filed a work injury claim against his company, David W. Heater, a sole proprietorship for which he was employed. The WCJ granted his claim petition finding that he gave timely notice of his injury and that he was injured in the course and scope of his employment. Erie Insurance appealed to the Board which upheld the judge’s decision. Insurer then appealed to the PA Commonwealth Court arguing that Claimant should have been required to give notice to Insurer within 120 days of the injury and the judge’s finding that Claimant’s notice of the injury on himself, as Employer, was sufficient is inconsistent with the purpose of Section 311 of the Act, prejudicial to the Insurer and a violation of Insurer’s due process rights. Claimant responded that the Board did not err in affirming the WCJ’s decision because neither Section 311 of the Act, nor precedent interpreting that provision, required him to provide notice to the Insurer as the Employer received timely notice of the injury. The Commonwealth Court reversed the Appeal Board holding that under these circumstances where a claimant is both the injured employee and the sole proprietor/.employer, the “employer” to whom the claimant must notify of a work-related injury for the purposes of Section 311 in the insurer that bears the ultimate liability for the claim. This allows the insurer to ensure that prompt and complete investigation into the claimed injury, that would normally be performed by a disinterested employer, can be performed to protect stale claims, thereby meeting the purpose of Section 311. Because Claimant did not provide timely notice to Insurer under Section 311, “no compensation shall be allowed” and Claimant’s Claim petition is barred. 23-page decision by Hon. Renee Chon Jubelirer, President Judge.
Paul C. Cipriano Jr., Esquire
Rulis & Bochicchio, LLC
June 2024
Tennessee Workers’
Compensation Legislative Changes
The 2024 year brings the
following legislative updates to Tennessee Workers’ Compensation Law: Public
Chapter 532; Public Chapter 666; Public Chapter 0813; Public Chapter 492;
Public Chapter 498; and Public Chapter 499. These legislative changes range
from clarifications to filing First Reports of Injury, to extensions of the
Bureau of Workers’ Compensation’s authority to enforce laws.
The first of several updates in
recent Tennessee Workers’ Compensation Law finds its place in the Public
Chapter 532. This Bill was signed by Governor Lee on March 7, 2024, and becomes
effective on July 1, 2024. This Bill amends current Tennessee laws to make
a consistent, uniform period of 14 days for electronic filing for the First
Report of Injury to the Bureau of Workers’ Compensation (BWC), as well as
removing the Notice of Controversy form requirement – a filing is now made
electronically via Electronic Data Interchange (EDI). This Bill further
provides clarification that uninsured employers penalties apply to construction
and non-construction entities. Finally, this Bill extends the sunset of PC 189 (2021)
until July 1, 2029 – allowing the Bureau of Workers’ Compensation to
continue to enforce workers’ compensation insurance coverage laws.
Another legislative change is
Public Chapter 666. This Bill enacts the Tennessee Self-Insurers’ Guaranty
Association Act, creating the Tennessee Self-Insurers’ Guaranty Association – a
nonprofit, unincorporated legal entity. The purpose of this Act is to provide
for a streamlined and more efficient process for the payment of self-insured
workers’ compensation claims. It will also serve as an avenue for the
assessment of costs of the protection among those self-insured. This Bill was
signed by Governor Lee on April 9, 2024, and became effective upon signing.
The legislative updates continue
with Public Chapter 0813. This Bill requires the Comptroller of the Treasury
(COT) to conduct a study of all insurers – including insurance pools – that
provide policies of workers’ compensation coverage to local government
entities. This will include a review of solvency and a comparative rate study.
The Bill additionally requires the COT to report the findings to the Speaker of
the Senate and the House of Representatives by January 1. 2025. This was signed
by Governor Lee on April 29, 2024, and became effective immediately.
The final legislative updates for
2024 lie in Public Chapter 492, Public Chapter 498, and Public Chapter 499.
These, respectively, (1) extend the Bureau of Workers’ Compensation to June 30,
2029; (2) extend the Medical Advisory Committee to June 30, 2029; and (3)
extend the Medical Payment Committee to June 30, 2029.
Each of the preceding bills have
been signed by Governor Bill Lee, and are either effective July 1st,
or were effective upon their signing.
For any questions, please
contact:
Fredrick R. Baker, Member
Brendan Walsh, Associate
Wimberly Lawson Wright Daves
& Jones, PLLC
1420 Neal Street, Suite 201
P.O. Box 655
Cookeville, TN 38503-0655
Phone: 931-372-9123
Fax: 931-372-9181
fbaker@wimberlylawson.com
bwalsh@wimberlylawson.com
www.wimberlylawson.com
Copyright 2024, Stone Loughlin & Swanson, LLP
A health care provider cannot submit a complaint about a medical billing issue if the date of service for the medical billing issue was more than 12 months before the date of the complaint, unless the issue qualifies for an exception to the filing deadline under §133.307(c)(1)(B) of this title, concerning medical fee dispute resolution. If the issue qualifies for an exception to the medical fee dispute resolution filing deadline under §133.307(c)(1)(B), then a health care provider cannot submit a complaint about that issue if the medical fee dispute resolution filing deadline in §133.307(c)(1)(B) has passed.The rule also notes, “This subsection does not apply to a health care provider submitting a complaint under Insurance Code Chapter 1305.” Section 1305.401 of the Workers’ Compensation Health Care Network Act requires each network to implement and maintain a complaint system to resolve complaints. A health care provider may submit a complaint to the network over a fee dispute and if dissatisfied with the outcome, the provider may file a complaint with TDI’s complaint resolution process.
