When “Accepted” Means “Denied” – Only in Pennsylvania Workers’ Compensation

When an employee in Pennsylvania gets injured, the PA Workers’ Compensation Act allots the workers’ compensation insurance carrier 21 days to investigate and accept or deny the claim.  If 21 days is not sufficient, the insurance carrier can opt to issue a Notice of Temporary Compensation Payable (NTCP or TNCP), and continue the investigation for up to 90 days more.  If the TNCP is not properly revoked within those 90 days, according to the Act, the TNCP becomes a regular Notice of Compensation Payable (NCP), and the injury can no longer be denied.  Simple, right?

Not so fast.  When a TNCP has been issued (for both wage loss and medical benefits), an insurance carrier can simply file a Medical-Only NCP, accepting liability solely for the medical aspect of the case (thus, denying liability for wage loss), without ever revoking that TNCP or issuing a Notice of Denial (NCD) for wage loss.  While this seems contrary to the words, if not the spirit, of the Act, the Commonwealth Court of Pennsylvania says this is perfectly fine.

This happened recently in an unreported case, Moretti v. County of Bucks (Workers’ Compensation Appeal Board), though prior reported decisions of the Commonwealth Court, supporting such a situation, were cited by the Court.

As attorneys who represent injured workers in PA, we are saddened that an Act said to be “remedial” and existing for the “benefit of the injured worker,” can allow a result such as this.  The TNCP is already widely abused by the insurance industry.  It is rarely used for the stated purpose (of providing additional time for investigation).  Instead, the main purpose of the TNCP is to be able to pay benefits, then still deny the claim when the injured worker goes back to work (creating a final ending to the claim that was not envisioned by the Act).  Giving additional latitude to the use of the TNCP is certainly to the detriment of the injured worker.

If you have been injured at work, and receive a TNCP, we would urge you to reach out to us, so your interests can be protected.  A TNCP is not what it would appear – it is a provisional “acceptance” which can easily still become essentially a “denial.”