Let’s face it. In today’s economy, most people are living paycheck to paycheck, with very little if any savings available as a safety net in the event of a disabling work injury. As such, one of the most frequently asked questions we hear from someone who has recently been injured is “when will I get paid?” Likewise, after someone begins receiving workers compensation benefits, issues frequently arise with the insurance carrier or self insured employer failing to make payments at a regular frequency. With rent or a mortgage, car payments and other bills due every month, uncertainty as to when workers compensation payments for a work related injury are to be received can be extremely stressful.
There are rules, however, as to when payments under the Pennsylvania Workers’ Compensation Act are supposed to been made. The basic rules are as follows:
1. An insurance carrier or self insured employer is required to give written notice to an employee within twenty-one days of the reporting of the injury of whether the claim is being accepted or denied. Insurance carriers usually will take every bit of this time, if not more (even though that is a violation of the law) to make a decision on whether they are going to accept t them make payment on a claim. A Us Csuch, following a work related injury, it is not at all uncommon for several weeks ago by before any payment of compensation is made.
2. If an injured worker misses less than seven days of work, no compensation benefits are payable. If less than fourteen days of disability occurs, the first seven days are not payable. However, if more than fourteen days of work are missed because of the injury, all days missed from the very first day are payable.
3. Benefits are payable “in periodical installments, as the wages of the employee were payable before the injury” under the Workers Compensation Act. This means that if an employee was paid weekly while working, they are entitled to weekly workers compensation checks. If they were paid biweekly, then the workers compensation checks are to be issued biweekly. This requirement of the Worker’s Compensation Act is frequently ignored by insurance carriers, and most often they issue checks on a biweekly basis.
4. Payments are not “late” if they are made on or before the day the employee’s paycheck was generally issued. If, for example, an employer pays wages every two weeks, with the last day of the pay period being a Friday and the paycheck issued on the following Monday, the insurance carrier has until that Monday to pay workers compensation benefits. At times insurance carriers will actually issue the compensation checks sooner than the employee would have received a paycheck. While there is nothing improper about the insurance carrier paying early, the injured worker will have difficulty convincing a Judge that anything was wrong if, at a later point, the insurance carrier then issues a check a few days later than it normally had been issued, provided it is still issued on or before the date that the employee’s paycheck typically would have been issued.
5. Penalties can be assessed against an insurance carrier that unreasonably or excessively delays payments of up to 50% of the amount involved. What is an unreasonable or excessive delay, however, has to be determined on a case-by-case basis and is largely within the discretion of a Workers Compensation Judge if the injured worker seeks penalties on the basis that payments were unreasonably or excessively delayed. Furthermore, a Worker’s Compensation Judge has the discretion to impose less than a 50% penalty, even if the Judge believes that payments were unreasonably and excessively delayed. As a practical matter, if an insurance carrier is a few days late in issuing a check, it is unlikely that any penalty will be assessed against the insurance carrier unless this is occurring on a regular basis.
6. The statement that a workers compensation check is not “late” as long as it is issued within thirty days of when it was due is wrong. It is a complete misconception and myth that a workers compensation check is not late unless it is issued more than thirty days after it is due. Many insurance adjusters, attorneys and even some Judges have this misconception. This misconception arises from the fact that a judgment against an employer cannot be filed unless a payment is more than thirty days late. However, the Commonwealth Court of Pennsylvania has specifically indicated that a check can be considered late, for which a penalty can be awarded, even if it is one day late without reasonable excuse.