Claims Kit

Physician Selection Provided by Workers' Compensation Statutes    306(f.1)(1)(i) 

If the employer has posted a list of six or more physicians or health care providers in the workplace, then the employee is required to visit one of them for initial treatment and continue treatment with that provider or another on the list for a period of 90 days following the first visit. The employee may choose any provider on the list. The employer can not require or direct the employee to any specific provider on the list. 

There are some specific guidelines provided in the rules and regulations for the provider lists: 

• The employer must provide a clearly written notice to employee of the employee's rights and duties. 
• The notice must be signed by the employee at the time of hire, whenever changes are made in the list and at the time of injury.  
• The list must contain at least six providers; three of the six providers must be physicians.  
• Providers as defined in the Act are more than just physicians.  
• Each provider's name, address, telephone number and specialty must be included on the list. 
• If a particular specialty is not on the list and the specialty care is reasonable and necessary for treatment of the work injury, the employee will be allowed to treat with a health care provider of his or her choosing. 
• The employer may not direct the employee to any specific provider on the list. 
• The employee may switch from one designated provider to another designated provider. 
• Listed providers must be geographically accessible. 
• Listed providers must contain specialties appropriate for the anticipated work-related medical problems of the employee. 

If the employer's list of designated providers fails to comply with the Act and the regulations, the employee has the right to treat with a provider of his or her choice.  

If a listed provider prescribes invasive surgery, the employee is entitled to a second opinion. Treatment recommended as a result of the second opinion must be provided by a listed provider for 90 days. After 90 days, the employee can seek treatment with any physician or other health care provider they select. The employee must notify their employer of the provider selected. The employer or the employer's insurance carrier is entitled to receive monthly reports from the physician or provider that is treating.

Reporting of Claim by Employer Rule 121.5

Employers must report injuries to their insurer or the administrator of a self-insured program and file a First Report of Injury form with the Bureau of Workers' Compensation within 48 hours for death injuries or within 7 days after the date disability begins for all other injuries. The employer must send a copy of the first report of injury to the employee at the same it is sent to the Bureau. 

If there is no disability, a copy of the report should not be sent to the Department.

Penalties for Late Reporting  435(i)

Employers and insurers may be penalized a sum not exceeding 10% of the amount awarded and interest accrued and payable: Provided, however, That the penalty may be increased to 50% in cases of unreasonable or excessive delays. Such penalty will be payable to the same persons to whom the compensation is payable.

Posting Requirements 305(e)

Every employer will post a notice at its primary place of business and at its sites of employment in a prominent and easily accessible place, including, without limitation, areas used for the treatment of injured employees or for the administration of first aid, containing:

•  Either the name of the employer's carrier and the address and telephone number of the carrier or insurer or, if the employer is self-insured, the name, address and telephone number of the person to whom claims or requests for information are to be addressed.
• The following statement: "Remember, it is important to tell your employer about your injury."

LIBC-500 poster           LIBC501 poster, Spanish

Notary Requirement for LIBC-751 (Notification of Modification/Suspension) as of Oct. 1, 2021

The Disaster Declaration’s temporary suspension of the notarization requirement of Form LIBC-751, Notification of Suspension or Modification, is still in effect and will expire on Sept. 30, 2021. After that date, parties will be required to obtain notarization of Form LIBC-751, Notification of Suspension or Modification.

Because Pennsylvanians might be exposed to COVID-19 in the workplace, the DLI isproviding important Pennsylvania Workers’ Compensation guidance regarding filing options and claims.

Two Filing Options for COVID-19

• Option 1:An employee can file a typical “disease-as-injury” workers’ compensation claim, which would require the employee to provide medical evidence that they were exposed to COVID-19 in the workplace. Employees must provide this type of evidence for all injury-related claims.

• Option 2:An employee could file an “occupational disease” workers’ compensation claim, which would require showing that COVID-19 is occurring more in the employee’s industry or occupation than in the general population, such as the healthcare industry.