You injured yourself at work and are receiving workers’ compensation benefits, and then you find out from the insurance company that even though they issued an NCP in your case and are paying you TTD benefits based on your AWW, because the IME doctor said you have recovered from your injuries and sent you a NOARTW, they are going to file a Termination Petition, which will be decided by the WCJ, and maybe they will file a UR Petition to stop your PT too. And you’re thinking – what does all that mean?
The Pennsylvania workers’ compensation system has a terminology all of its own. Many terms are shortened to abbreviations formed from the initial letters of each of the words. These are also known as acronyms. We want you to understand all of this lingo, so we’re going to explain to you what each of these acronyms stands for and what they mean in your workers’ comp. case.
An NCP stands for notice of compensation payable. When you report your work injury, the insurance company has 21 days to accept your claim by issuing a notice of compensation payable or denying your claim by issuing a notice of compensation denial (NCD). They can also issue a MONCP – or a medical-only notice of compensation payable, in which they accept the medical part of your claim, but deny that you are disabled as a result of your injury and don’t pay you money for your lost wages; they only have agreed to pay your medical bills.
If they send out a notice of compensation payable and agree to start paying you for your lost wages, the amount will be computed by determining your AWW – your average weekly wage – which is a calculation of your gross weekly income for your employer. Based on a formula, which looks back at the one-year period preceding your date of your injury, your average weekly wage is calculated. Based on that figure, the insurance company will determine your TTD rate – or temporary total disability compensation rate. This number is normally between 2/3 and 90% of your average weekly wage. If you are a high wage earner, your total disability compensation rate could be less than 2/3 of your average weekly wage.
Every six months, the insurance company is permitted to have you evaluated by a doctor of its choice for an IME – an independent medical examination. At that evaluation, the doctor will ask you questions about your injury and treatment you have received, examine you, review medical records, and then write a report stating his or her opinions with regard to your current condition, whether you require additional treatment for your injury, and your ability to work. If the doctor concludes you have fully recovered, the insurance company will petition to terminate your benefits and will send you a NOARTW – a notice of ability to return to work, signifying that in the doctor’s opinion, you have recovered from your injury and are able to go back to work. If the doctor concludes you haven’t recovered but are able to perform light-duty work, you will still be sent a notice of ability to return to work.
A UR Petition is a Utilization Review Petition. The insurance company can challenge whether your medical treatment is reasonable and necessary. Initially, a medical provider in the same specialty as the provider who is rendering the treatment in question will review the records, along with a written statement by you, and write a report, stating whether this is reasonable and necessary treatment for your work injury. So if you are undergoing PT – or physical therapy – a physical therapist will review the records of your physical therapist, along with the medical records of other doctors who have treated you, and provide an opinion on whether your therapy is reasonable and necessary. This determination can be appealed to a WCJ, or a Workers’ Compensation Judge, who will hear and make decisions on all of the petitions filed in your case. Hearings will be held before the Workers’ Compensation Judge, depositions will be taken, and then the Judge will issue a decision in your case.
When you testify before the Workers’ Compensation Judge, you may be asked if you are receiving SSD benefits – or Social Security disability benefits. If you have been approved for Social Security benefits, and are on Medicare or eligible for Medicare, in order to reach a settlement in your case, the insurance company will have to pay for an MSA – a Medicare Set-Aside. In other words, the insurance company will have to pay a certain amount of money to cover your future medical bills for your work injury before you can submit the bills to Medicare. And if you settle your case, regardless of whether there is a Medicare-Set Aside, you will have to enter into a C & R Agreement – a Compromise and Release Agreement, which the Judge will have to approve at a hearing.
Don’t let all of this terminology stress you out – you’re already dealing with enough aggravation after injuring yourself and being unable to work. Call the office of PK Law – Pearson Koutcher Law – and one of our knowledgeable and experienced workers’ compensation lawyers will evaluate your case and represent you so you don’t have to fight the insurance company alone. So if you don’t have a top lawyer from PK by your side, unfortunately, you may be out of luck before the WCJ.