Statute of Repose.
Section 315 of the Pennsylvania Workers’ Compensation Act, 77 P.S. §602 requires the filing of a Claim Petition within three years after the date of injury. This three year statute of repose pertains to claims for medical benefits only as well as combined disability/medical cases. In cases involving cumulative trauma injury, the medical testimony can be determinative as to the date of injury for statute of limitation purposes. Where the medical evidence establishes that ongoing work activities aggravated the Claimant’s condition, the last date of work is considered to be the date of injury. If however the Claimant has lost no time from work, the date of injury is the date of diagnosis. There is case law which holds that it is the effective date of disability as opposed to the date of trauma that governs commencement of the three year limitation.
The statue of repose for death claims is also three years, with Section 315 of the Act requiring the filing of a Claim Petition within three years after date of death. However, for the death to be compensable, it must occur within 300 weeks after the injury even if the Claimant is receiving ongoing benefits for the entire 300 week period.
For specific loss claims, the date of injury for statute of limitation purposes is the date when the Claimant is notified by a physician of the loss of use of the member or faculty for all practical intents and purposes and that the injury is job related in nature. In a situation where the only injury is disfigurement, a Petition must be filed within three years unless the employee proves that the disfigurement only became permanent and unsightly within three years of the filing.
Extension of Limitation.
Section 315 of the Act also provides that the limitation period shall not begin to run where compensation has been paid or payments have been made in lieu of compensation until three years following the last payment. To toll the three year statute the Claimant has the burden of demonstrating that the payments of medical expenses were “payments of compensation” by establishing that the injury was work related and that the payments were made with the intent that they be “in lieu of workmen’s’ compensation.”
What are considered payments in lieu of compensation has been considered by both the Commonwealth and Superior Courts of Pennsylvania. These payments can include regular payments from general funds, and sick, accident or relief funds to which the employer contributes, provided the payments are made without Claimant’s performing work. The burden of proof is on the Claimant to establish that these payments were made as compensation in order to toll the statute of limitations, though payments made under a short term disability plan must be identified as not being workers’ compensation in order to be considered as payments made in lieu of compensation, and payments made under a management disability plan that are reduced by any workers’ compensation benefits received by the Claimant constitute payments in lieu of compensation. For the most recent case law addressing the issue of payments “in lieu of workmen’s’ compensation” see Schreffler v. WCAB (Kocher Coal Company), 788 A.2d 963 (PA 2002).
Per Section 311 of the Pennsylvania Workers’ Compensation Act, 77 P.S. §631, notice is required within 120 days of the injury. This 120 days for giving notice of an injury does not begin to run until the employee knows, or by the exercise of a reasonable diligence should know, of the existence of the injury and its possible relationship to his or her employment. Thus, even if a Claim Petition is filed within three years of Claimant’s disability, if the Claimant has not given notice of injury to his employer within 120 days of the injury, Claimant’s injury will not be compensable. Like the three year statute of repose for filing of a petition, the 120 notice period can be extended in situations where the Claimant is exposed to continuing multiple trauma, with the injury being deemed to have taken place on the last day of work. Additionally, the date of diagnosis can also be determined to be the date of injury for beginning notice.
Time Limitations for Reinstatement of Benefits.
Reinstatement after Termination or Final Receipt.
Under Section 434 of the Act, 77 P.S. §1001, the Petition for Reinstatement following termination or final receipt must be filed within three years of the date to which compensation payments have been made. This three year period runs from the last date of payment of compensation or wages in lieu of compensation or from the date of any act of deception by the employer or carrier that lulled the Claimant into believing his or her claim would be considered, notwithstanding the final receipt. The time period within which to file a Petition to set aside a final receipt is not extended by the payment of medical bills. The term “compensation” does not include the payment of medical expenses for purposes of the running of the statute of limitations in Section 434 of the Act. The three year period does not apply where a final receipt is obtained by fraud, intentional or unintentional deception, or other improper action of the employer.
If the Claimant files a timely Petition for Reinstatement following termination or final receipt, Claimant must prove that his disability has increased or recurred after the date of the termination or final receipt and must prove that his physical condition has actually changed in some manner.
Reinstatement from Suspension or Modification.
A Petition to reinstate compensation benefits by a Claimant whose benefits have been modified or suspended may be filed at any time during the 500 week partial disability period provided by the Act. A Claimant who has exhausted his 500 weeks of eligibility for partial disability may file a Petition to Modify/Reinstate to total disability within three years after the final payment made during the 500 weeks. (Some analysists have interpreted the recent case of Kaiser v. WCAB (Weleski Transfer, Inc.), 809 A.2d 1088 (Pa. Cmwlth. 2002), to stand for the proposition that a Claimant has three years from expiration of the 500 weeks within which to file for reinstatement notwithstanding the date of last payment, though this interpretation has not been endorsed by the Pennsylvania Supreme Court as of this writing.)
Other Time Provisions.
21 Day Notice.
If an employee does not give notice of his injury to his employer within 21 days, no compensation shall be due to the Claimant even in a compensable case, until the date of actual notice.
30 Day Periods.As a general proposition under the Act, medical expenses must be paid within 30 days of receipt of the billing forms, provided that the billing forms conform to the provisions of the Workers’ Compensation Act. Similarly, Judge’s decisions that create payment obligations must be satisfied within 30 days of the decision circulation date, though appeal to the Workers’ Compensation Appeal with Request for Supersedeas may extend this period during the time which the Board is considering the Supersedeas request itself.