reglab/statecodes huggingface dataset:
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 122 - GENERAL PROVISIONS OF ACT 57 OF 1996-STATEMENT OF POLICY › Subchapter G - COORDINATED CARE ORGANIZATIONS-STATEMENT OF POLICY › Section 122.623 - Data reporting requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A CCO
				  shall file an annual report with the Department for each 12 months of
				  operation. This report shall be filed with the Department within 60 days after
				  the end of each 12-month period and shall summarize the CCO's activities during
				  the preceding 12-month period and include the following:
(1) The number of self-insured employers
				  which had offered the CCO to injured workers during the reporting period as one
				  of the specified providers under section 306(f.1)(1)(i) of the act
				  (77
				  P. S. §
												531.1(1)(i)).
(2) The number of workers' compensation
				  insurers which had offered the CCO during the reporting period as one of the
				  specified providers under section 306(f.1)(1)(i) of the act.
(3) The total number of workers eligible to
				  utilize the CCO during the reporting period.
(4) The number of workers who actually
				  utilized the CCO during the reporting period and the length of time of the
				  utilization.
(5) The number of each
				  of the following for the reporting period: complaints and grievances filed,
				  resolved in favor of the injured worker, decided in favor of the CCO or
				  participating coordinated care provider, pending resolution and appealed by
				  injured workers to the Department.
(6) The number of each of the following for
				  the reporting period: utilization review decisions appealed by participating
				  coordinated care providers, settled in favor of the provider, settled in favor
				  of the CCO and pending resolution.
(7) The number of injured workers during the
				  reporting period who initially selected the CCO and were still under treatment
				  31 days after the injury and receiving care through the CCO, and who initially
				  selected the CCO and were still under treatment 31 days after the injury and
				  who exercised their option to seek continued treatment from non-CCO
				  providers.
(8) The number of
				  injured workers during the reporting period who selected the CCO option who
				  returned to work within: 0-7 days; 8-14 days; 15-30 days; 31-40 days; 41-50
				  days; 51-60 days; 61-365 days; or more than 365 days after injury.
(9) The number of workers during the
				  reporting period who were reinjured or requiring medical services relating to
				  the original injury within: 0-7 days; 8-30 days; 31-90 days; 91-365 days of
				  their return to work.
(10) The
				  record of timeliness of delivery of services during the reporting period, as
				  required by §
											122.609(d)
				  (relating to requirements for a CCO's health service delivery
				  system).
(11) The cost of providing
				  services to injured workers, for the reporting period, in a form and with
				  specificity the Department may require.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 122 - GENERAL PROVISIONS OF ACT 57 OF 1996-STATEMENT OF POLICY › Subchapter G - COORDINATED CARE ORGANIZATIONS-STATEMENT OF POLICY › Section 122.624 - Requirements for service area expansion

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A CCO may apply for approval of an
				  expansion of its service area by submitting a request for the expansion to the
				  Department. The expansion request shall include the following:
(1) The proposed new service area, by
				  county.
(2) A list of participating
				  coordinated care providers in the proposed new service area who are capable of
				  providing primary medical services and other required health services in a
				  manner that meets the standards in §
											122.609 (relating to requirements
				  for a CCO's health service delivery system).
(3) A description of how required services
				  such as case management and communication, utilization review and quality
				  assurance will be extended to serve injured workers in the proposed additional
				  service area and a description of the CCO's plans for increased staffing to
				  expand these services.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 122 - GENERAL PROVISIONS OF ACT 57 OF 1996-STATEMENT OF POLICY › Subchapter G - COORDINATED CARE ORGANIZATIONS-STATEMENT OF POLICY › Section 122.625 - Injured worker literature

Current through Register Vol. 54, No. 28, July 13, 2024
As soon as practical after an injured worker's initial
					 contact with a CCO, the CCO shall provide the injured worker with a written
					 description of the CCO structure, operation, provider network, quality
					 assurance system, utilization review system, grievance resolution system,
					 alternatives to the grievance resolution system, referral requirements and
					 methods by which the injured worker may change providers or initiate a referral
					 within the provider network. The CCO may arrange with an employer for the
					 employer or insurer to distribute the literature to injured
					 workers.
This section cited in 34 Pa. Code §
												122.608 (relating to contents of
						an application for certification as a
						CCO).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 122 - GENERAL PROVISIONS OF ACT 57 OF 1996-STATEMENT OF POLICY › Subchapter G - COORDINATED CARE ORGANIZATIONS-STATEMENT OF POLICY › Section 122.626 - Contracts with independent organizations for performance of case management and communication or utilization review services

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A CCO shall provide quality assurance and
				  injured worker grievance system services directly.
(b) A CCO may, with the prior approval of the
				  Department, contract with an independent organization for the conduct of
				  utilization review or case management and communication services for injured
				  workers treated by the CCO.
(c) A
				  CCO that intends to enter into a contract subject to subsection (b), after it
				  becomes certified, shall submit the contract for review and approval by the
				  Department before it enters into the contract.
(d) The CCO will be held by the Department to
				  have ultimate responsibility and accountability for services provided by a
				  contractor to injured workers pursuant to a contract subject to subsection
				  (b).
(e) A contract subject to
				  subsection (b) shall contain provisions which provide that:
(1) The ultimate responsibility and
				  accountability for services provided by the contractor to injured workers is
				  retained by the CCO.
(2) The CCO
				  has authority to establish performance standards, monitor performance of the
				  contractor, require corrective action and terminate the contract if the
				  contractor is found by the CCO to be ineffective or to be conducting activities
				  detrimental to the CCO or injured workers.
(3) The Department has approval authority
				  over the contract and authority to require the CCO to take corrective
				  action.
(4) The CCO and the
				  Department shall have access to records, including medical records, relating to
				  the provision of services to injured workers electing to receive care through
				  the CCO.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 122 - GENERAL PROVISIONS OF ACT 57 OF 1996-STATEMENT OF POLICY › Subchapter G - COORDINATED CARE ORGANIZATIONS-STATEMENT OF POLICY › Section 122.627 - Changes or additions to previously approved application

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Except as set forth in subsection (b), a
				  CCO may not engage in a material departure in its operations from the manner
				  described in the information submitted with its application for certification
				  without filing the proposed changes with the Department 60 days prior to the
				  intended effective date of the changes. The filings shall be subject to the
				  following:
(1) A CCO may not implement changes
				  in contracts with participating coordinated care providers, other than as to
				  negotiated fee levels, without specific approval of the Department.
(2) A CCO may implement a change or addition
				  after expiration of the 60-day filing period if this subchapter does not
				  specifically state that that type of change or addition requires prior
				  Departmental approval and if the Department does not notify the CCO within 60
				  days of its receipt of the proposed change or addition that the change or
				  addition is significant enough to require specific prior review and approval of
				  the Department. If so notified by the Department, the CCO may not implement the
				  change or addition until the Department has formally approved the change or
				  addition.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.1 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter interprets the provisions of the act which
					 authorize the offset of workers' compensation benefits by amounts received in
					 unemployment compensation, Social Security (old age), severance and pension
					 benefits, subsequent to the work-related injury. Offsets shall be
					 dollar-for-dollar and calculated as set forth in §§
										123.4-123.11. Offsets in excess of the
					 weekly workers' compensation rate shall accumulate as a credit toward the
					 future payment of workers' compensation benefits.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.3 - Employe report of benefits subject to offset

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Employees shall report to the insurer
				  amounts received in unemployment compensation, Social Security (old age),
				  severance and pension benefits on form LIBC-756, "Employee's Report of
				  Benefits." This includes amounts withdrawn or otherwise utilized from pension
				  benefits which are rolled over into an IRA or other similarly restricted
				  account while at the same time the employee is receiving workers' compensation
				  benefits.
(b) Form LIBC-756 shall
				  be completed and forwarded to the insurer within 30 days of the employee's
				  receipt of any of the benefits specified in subsection (a) or within 30 days of
				  any change in the receipt of the benefits specified in subsection (a), but at
				  least every 6 months.
This section cited in 34 Pa. Code §
												123.4 (relating to application of
						the offset generally); and 34 Pa. Code §
												123.5 (relating to offset for
						benefits already received).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.4 - Application of the offset generally

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  After receipt of Form LIBC-756, the insurer may offset workers' compensation
				  benefits by amounts received by the employee from any of the sources in §
										123.3 (relating to employee report
				  of benefits subject to offset). The offset of workers' compensation benefits
				  only applies with respect to amounts of unemployment compensation, Social
				  Security (old age), severance and pension benefits received subsequent to the
				  work-related injury.
(1) The offset applies
				  only to wage-loss benefits (as opposed to medical benefits, specific loss or
				  survivor benefits).
(2) The offset
				  for amounts received in Social Security (old age), severance and pension
				  benefits only applies to individuals with claims for injuries suffered on or
				  after June 24, 1996.
(3) The offset
				  for amounts received in unemployment compensation benefits applies to all
				  claims regardless of the date of injury.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.5 - Offset for benefits already received

Current through Register Vol. 54, No. 28, July 13, 2024
(a) If the insurer receives information that
				  the employee has received benefits from one or more of the sources in §
										123.3 (relating to employee report
				  of benefits subject to offset) subsequent to the date of injury, the insurer
				  may be entitled to an offset to the workers' compensation benefit.
(b) The net amount received by the employee
				  shall be calculated consistent with §§
										123.6-123.11. The amount received by the
				  employee shall be divided by the weekly workers' compensation rate. The result
				  shall be the number of weeks, and fraction thereof, the insurer is entitled to
				  offset against future payments of workers' compensation benefits.
(c) The insurer shall notify the employee,
				  the employee's counsel, if known, and the Department of the offset as specified
				  in §
										123.4(b)
				  (relating to application of the offset generally).
(d) The employee may challenge the offset by
				  filing a petition to review offset with the Department.
This section cited in 34 Pa. Code §
												123.1 (relating to
						purpose).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.6 - Application of offset for Unemployment Compensation (UC) benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Workers'
				  compensation benefits otherwise payable shall be offset by the net amount an
				  employe receives in UC benefits subsequent to the work-related injury. This
				  offset applies only to UC benefits which an employe receives and which are
				  attributable to the same time period in which an employe also receives workers'
				  compensation benefits.
(b) The
				  offset may not apply to benefits for which an employe may be eligible, but is
				  not receiving.
(c) The offset to
				  workers' compensation benefits for amounts received in UC benefits is triggered
				  when an employe becomes eligible for and begins receiving the UC benefits.
(1) When an employe receives UC benefits
				  which the employe is later required to repay based upon a determination of
				  ineligibility, the insurer may not offset the workers' compensation
				  benefits.
(2) When an employe's
				  workers' compensation benefits have been offset by the amount received in UC
				  benefits, and the employe is required to repay UC benefits based upon a
				  determination of ineligibility, the insurer shall repay the employe for the
				  amounts previously offset from the workers' compensation benefits. The employe
				  may request that the insurer remit repayment directly to the Bureau of
				  Unemployment Compensation Benefits and Allowances (BUCBA).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.7 - Application of offset for Social Security (old age) benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Workers' compensation benefits otherwise
				  payable shall be offset by 50% of the net amount received in Social Security
				  (old age) benefits. The offset shall only apply to amounts which an employe
				  receives subsequent to the work-related injury. The offset may not apply to
				  Social Security (old age) benefits which commenced prior to the work-related
				  injury and which the employe continues to receive subsequent to the
				  work-related injury.
(b) The offset
				  may not apply to benefits to which an employe may be entitled, but is not
				  receiving.
(c) The offset shall be
				  applied on a weekly basis. To calculate the weekly offset, 50% of the net
				  monthly Social Security (old age) benefit received by the employe shall be
				  divided by 4.34.
This section cited in 34 Pa. Code §
												123.1 (relating to purpose); and
						34 Pa. Code §
												123.5 (relating to offset for
						benefits already received).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.8 - Offset for pension benefits generally

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Workers' compensation benefits otherwise
				  payable shall be offset by the net amount an employe receives in pension
				  benefits to the extent funded by the employer directly liable for the payment
				  of workers' compensation.
(b) The
				  pension offset shall apply to amounts received from defined-benefit and
				  defined-contribution plans.
(c) The
				  offset may not apply to pension benefits to which an employe may be entitled,
				  but is not receiving.
(d) In
				  calculating the offset amount for pension benefits, investment income
				  attributable to the employer's contribution to the pension plan shall be
				  included on a prorata basis.
This section cited in 34 Pa. Code §
												123.1 (relating to purpose); and
						34 Pa. Code §
												123.5 (relating to offset for
						benefits already received).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.10 - Multiemployer pension fund offsets

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  When the pension benefit is payable from a multi-employer pension plan, only
				  that amount which is contributed by the employer directly liable for the
				  payment of workers' compensation shall be used in calculating the offset to
				  workers' compensation benefits.
(b)
				  To calculate the appropriate offset amount, the portion of the annuity
				  purchased by the liable employer's contributions shall be as determined by the
				  pension fund's actuary. The ratio of the portion of the annuity purchased by
				  the liable employer's contributions to the total annuity shall be multiplied by
				  the net benefit received by the employee from the pension fund on a weekly
				  basis. The result is the amount of the offset to be applied to the workers'
				  compensation benefit on a weekly basis.
(c) If the employee receives the
				  multi-employer pension benefit on a monthly basis, the net amount received by
				  the employe shall be multiplied by the ratio of the liable employer's
				  contribution to the pension plan on behalf of the employee and that product
				  shall be divided by 4.34. The result is the amount of the offset to be applied
				  to the workers' compensation benefit on a weekly basis.
(d) If the employee receives the
				  multi-employer pension benefit in a lump sum, the actuarial equivalent of the
				  lump sum with respect to the annuity options (qualified joint and survivor
				  annuity or life annuity) available at the time of the employee's receipt of the
				  benefit shall be used as the basis for calculating the offset to the workers'
				  compensation benefit. The ratio of the employer's contribution to the pension
				  plan shall be multiplied by the monthly annuity value of the pension benefit.
				  The result shall be divided by 4.34 to achieve the offset to the workers'
				  compensation benefit on a weekly basis.
This section cited in 34 Pa. Code §
												123.1 (relating to purpose); and
						34 Pa. Code §
												123.5 (relating to offset for
						benefits already received).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter A - OFFSET OF UNEMPLOYMENT COMPENSATION,SOCIAL SECURITY (OLD AGE), SEVERANCE ANDPENSION BENEFITS › Section 123.11 - Application of offset for severance benefits

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Workers' compensation benefits otherwise
				  payable shall be offset by amounts an employee receives in severance benefits
				  subsequent to the work-related injury. The offset may not apply to severance
				  benefits to which an employee may be entitled, but is not receiving.
(b) The net amount of any severance benefits
				  shall offset workers' compensation benefits on a weekly basis except as
				  provided in subsections (c) and (d).
(c) When the employee receives severance
				  benefits in a lump-sum payment, the net amount received by the employee shall
				  be divided by the weekly workers' compensation rate. The result is the number
				  of weeks, and fraction thereof, the insurer may offset against future payments
				  of workers' compensation benefits.
(d) When an employee receives a severance
				  benefit in the form of tangible property, the market value of the property, as
				  determined for Federal tax purposes, shall be divided by the weekly workers'
				  compensation rate. The result is the number of weeks, and fraction thereof, the
				  insurer may offset against future payments of workers' compensation
				  benefits.
This section cited in 34 Pa. Code §
												123.1 (relating to purpose); and
						34 Pa. Code §
												123.5 (relating to offset for
						benefits already received).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter B - IMPAIRMENT RATINGS › Section 123.101 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter interprets section 306(a.2) of the act
					 (77
					 P. S. §
											511.2) which provides for a
					 determination of whole body impairment due to the compensable injury after the
					 receipt of 104 weeks of total disability compensation, unless otherwise agreed
					 to by the parties.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter B - IMPAIRMENT RATINGS › Section 123.102 - IRE requests

Current through Register Vol. 54, No. 28, July 13, 2024
(a) During
				  the 60-day period subsequent to the expiration of the employee's receipt of 104
				  weeks of total disability benefits, the insurer may request the employee's
				  attendance at an IRE. If the evaluation is scheduled to occur during this
				  60-day time period, the adjustment of the benefit status shall relate back to
				  the expiration of the employee's receipt of 104 weeks of total disability
				  benefits. In all other cases, the adjustment of the disability status shall be
				  effective as of the date of the evaluation or as determined by the evaluating
				  physician.
(b) Absent agreement
				  between the insurer and the employee, an IRE may not be performed prior to the
				  expiration of the employee's receipt of 104 weeks of total disability
				  benefits.
(c) When an insurer
				  requests the employee's attendance at an IRE during the 60-day period
				  subsequent to the expiration of the employee's receipt of 104 weeks of total
				  disability benefits and the employee fails, for any reason, to attend the IRE,
				  when the failure results in the performance of the IRE more than 60 days beyond
				  the expiration of the 104-week period, the adjustment of disability status
				  shall relate back to the expiration of the employee's receipt of 104 weeks of
				  total disability benefits.
(d) The
				  employee's receipt of 104 weeks of total disability benefits shall be
				  calculated on a cumulative basis.
(e) The insurer shall request the employee's
				  attendance at the IRE in writing on Form LIBC-765, "Impairment Rating
				  Evaluation Appointment," and specify therein the date, time and location of the
				  evaluation and the name of the physician performing the evaluation, as agreed
				  by the parties or designated by the Department. The request shall be made to
				  the employee and employee's counsel, if known.
(f) Consistent with section 306(a.2)(6) of
				  the act (77 P. S. §
											511.2), the
				  insurer's failure to request the evaluation during the 60-day period subsequent
				  to the expiration of the employee's receipt of 104 weeks of total disability
				  benefits may not result in a waiver of the insurer's right to compel the
				  employee's attendance at an IRE.
(g) The insurer maintains the right to
				  request and receive an IRE twice in a 12-month period. The request and
				  performance of IREs may not preclude the insurer from compelling the employee's
				  attendance at independent medical examinations or other expert interviews under
				  section 314 of the act (77 P. S. §
											651).
(h) The employee's failure to attend the IRE
				  under this section may result in a suspension of the employee's right to
				  benefits consistent with section 314(a) of the act.
This section cited in 34 Pa. Code §
												123.105 (relating to impairment
						rating determination).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter B - IMPAIRMENT RATINGS › Section 123.103 - Physicians

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Physicians
				  performing IREs shall:
(1) Be licensed in
				  this Commonwealth and certified by an American Board of Medical
				  Specialties-approved board or its osteopathic equivalent.
(2) Be active in clinical practice at least
				  20 hours per week.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter B - IMPAIRMENT RATINGS › Section 123.104 - Initial IRE; designation of physician by Department

Current through Register Vol. 54, No. 28, July 13, 2024
(a) The insurer is responsible for scheduling
				  the initial IRE. Only the insurer may request that the Department designate an
				  IRE physician.
(b) The Department's
				  duty to designate an IRE physician pertains only to the initial IRE. A list of
				  Departmentally approved IRE physicians will be available upon
				  request.
(c) The request to
				  designate a physician shall be made on Form LIBC-766, "Request for Designation
				  of a Physician to Perform an Impairment Rating Evaluation."
(d) Within 20 days of receipt of the
				  designation request, the Department will designate a physician to perform the
				  IRE.
(e) The Department will
				  provide the name and address of the physician designated to perform the IRE to
				  the employee, the insurer and the attorneys for the parties, if
				  known.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter B - IMPAIRMENT RATINGS › Section 123.105 - Impairment rating determination

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  When properly requested under §
										123.102 (relating to IRE
				  requests), an IRE shall be conducted in all cases and an impairment rating
				  determination must result under the most recent edition of the AMA "Guides to
				  the Evaluation of Permanent Impairment."
(b) To ascertain an accurate percentage of
				  the employee's whole body impairment, when the evaluating physician determines
				  that the compensable injury incorporates more than one pathology, the
				  evaluating physician may refer the employee to one or more physicians
				  specializing in the specific pathologies which constitute the compensable
				  injury. Any physician chosen by the evaluating physician to assist in
				  ascertaining the percentage of whole body impairment shall possess the
				  qualifications as specified in §
										123.103(a) and
				  (b) (relating to physicians). The referring
				  physician remains responsible for determining the whole body impairment rating
				  of the employee.
(c) The physician
				  performing the IRE shall complete Form LIBC-767, "Impairment Rating
				  Determination Face Sheet" (Face Sheet), which sets forth the impairment rating
				  of the compensable injury. The physician shall attach to the Face Sheet the
				  "Report of Medical Evaluation" as specified in the AMA "Guides to the
				  Evaluation of Permanent Impairment." The Face Sheet and report shall be
				  provided to the employee, employee's counsel, if known, insurer and the
				  Department within 30 days from the date of the impairment evaluation.
(d) If the evaluation results in an
				  impairment rating of less than 50%, the employee shall receive benefits partial
				  in character. To adjust the status of the employee's benefits from total to
				  partial, the insurer shall provide notice to the employee, the employee's
				  counsel, if known, and the Department, on Form LIBC-764, "Notice of Change of
				  Workers' Compensation Disability Status," of the following:
(1) The evaluation has resulted in an
				  impairment rating of less than 50%.
(2) Sixty days from the date of the notice
				  the employee's benefit status shall be adjusted from total to
				  partial.
(3) The adjustment of
				  benefit status does not change the amount of the weekly workers' compensation
				  benefit.
(4) An employee may only
				  receive partial disability benefits for a maximum of 500 weeks.
(5) The employee may appeal the adjustment of
				  benefit status to a workers' compensation judge by filing a Petition for Review
				  with the Department.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.201 - Purpose

Current through Register Vol. 54, No. 28, July 13, 2024
This subchapter implements and interprets provisions of the
					 act which permit the Department to establish qualifications for vocational
					 experts who will conduct earning power assessment interviews under sections
					 306(b) and 449 of the act (77 P. S. §§
											512 and
					 1000.5). This subchapter also
					 implements the act's requirements for compliance with the Code of Professional
					 Ethics for Rehabilitation Counselors pertaining to the conduct of expert
					 witnesses and disclosure of financial interest.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.201b - Definitions

Current through Register Vol. 54, No. 28, July 13, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
Financial interest
-An interest equated
					 with money or its equivalent, and includes any of the following:
(i) A present or former ownership interest in
				  or with the entity or individual conducting the earning power assessment
				  interview.
(ii) A present or former
				  employment relationship with the entity or individual conducting the earning
				  power assessment interview.
(iii) A
				  contractual or referral arrangement that would require or allow the insurer to
				  provide compensation or other consideration based upon the vocational expert's
				  opinion or the outcome of the vocational expert's earning power assessment
				  interview.
Insurer
-An insurer is any of the
					 following:
(i) A workers' compensation
				  insurance carrier.
(ii) The State
				  Workers' Insurance Fund of the Department.
(iii) An employer authorized by the
				  Department to self-insure its workers' compensation liability under section 305
				  of the act (77 P. S. §
											501).
(iv) A group of employers authorized by the
				  Department to act as a self-insurance fund under section 802 of the act
				  (77
				  P. S. §
											1036.2).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.202 - Qualifications for current vocational experts under Act 57 of 1996

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This section
				  applies to individuals who, before June 23, 2007, conducted earning power
				  assessment interviews under section 306(b) of the act (77 P. S. §
											512). These individuals continue to meet the
				  minimum qualifications established under section 306(b) if they possess one of
				  the following:
(1) Both of the following:
(i) Certification by one of the following
				  Nationally recognized professional organizations:
(A) The American Board of Vocational
				  Experts.
(B) The Commission on
				  Rehabilitation Counselor Certification.
(C) The Commission on Disability Management
				  Specialists Certification.
(D) The
				  National Board of Certified Counselors.
(E) Other Nationally recognized professional
				  organizations, published by the Department in the
Pennsylvania
				  Bulletin
.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.202a - Qualifications for vocational experts under Act 53 of 2003

Current through Register Vol. 54, No. 28, July 13, 2024
(a) This section applies to individuals who,
				  before June 23, 2007, have not conducted earning power assessment interviews
				  under section 306(b) of the act (77 P. S. §
											512). These individuals meet the minimum
				  qualifications established under section 306(b) if they possess both:
(1) Certification by one of the following
				  Nationally recognized professional organizations:
(i) The American Board of Vocational
				  Experts.
(ii) The Commission on
				  Rehabilitation Counselor Certification.
(iii) The Commission on Disability Management
				  Specialists Certification.
(iv)
				  Other Nationally recognized professional organizations, published by the
				  Department in the
Pennsylvania Bulletin
.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.203 - Role of workers' compensation judges

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A workers' compensation judge will
				  resolve disputes regarding whether a vocational expert meets the minimum
				  qualifications established in §§
										123.202 and
				  123.202a (relating to
				  qualifications for current vocational experts under Act 57 of 1996; and
				  qualifications for vocational experts under Act 53 of 2003).
(b) Except as set forth in subsection (c),
				  this subchapter does not limit a workers' compensation judge's authority to
				  determine a vocational expert's qualifications under §§
										123.202 and
				  123.202a or a vocational expert's
				  bias or objectivity.
(c) A workers'
				  compensation judge may not consider the results of an earning power assessment
				  interview if the workers' compensation judge finds that the vocational expert
				  has not complied with §
										123.204 (relating to conduct of
				  vocational experts) or that the insurer has not complied with §
										123.205 (relating to financial
				  interest disclosure).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.204 - Conduct of vocational experts

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  Before conducting an earning power assessment interview, the vocational expert
				  shall disclose to the employee, in writing, the role and limits of the
				  vocational expert's relationship with the employee.
(b) A vocational expert who conducts an
				  earning power assessment interview shall generate a written initial report
				  detailing the expert's involvement in the litigation and conclusions from the
				  interview. The initial report need not contain the results or conclusions of
				  any surveys or tests. The vocational expert shall serve a copy of the initial
				  report on the employee and counsel, if known, within 30 days of the date of the
				  interview.
(c) A vocational expert
				  who authors additional written reports, including earning power assessments or
				  labor market surveys, shall simultaneously serve copies of these written
				  reports upon the employee and counsel, if known, when the expert provides the
				  written reports to the insurer or its counsel.
(d) A vocational expert who satisfies the
				  requirements of this section complies with the Code of Professional Ethics for
				  Rehabilitation Counselors pertaining to the conduct of expert witnesses for
				  purposes of section 306(b)(2) of the act (77 P. S. §
											512(2)).
This section cited in 34 Pa. Code §
												123.203 (relating to role of
						workers' compensation judges).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter C - QUALIFICATIONS FOR VOCATIONAL EXPERTS APPROVED BY THE DEPARTMENT › Section 123.205 - Financial interest disclosure

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  For the purposes of this section, a third-party administrator or another entity
				  that performs services on behalf of an insurer, as specified in section 441(c)
				  of the act (77 P. S. §
											997(c)), is an
				  insurer.
(b) Before an insurer
				  refers an employee for an earning power assessment interview, the insurer shall
				  disclose to the employee, in writing, any financial interest the insurer has
				  with the person or entity conducting the earning power assessment
				  interview.
This section cited in 34 Pa. Code §
												123.203 (relating to role of
						workers' compensation judges).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter D - EARNING POWER DETERMINATIONS › Section 123.301 - Employer job offer obligation

Current through Register Vol. 54, No. 28, July 13, 2024
(a) For
				  claims for injuries suffered on or after June 24, 1996, if a specific job
				  vacancy exists within the usual employment area within this Commonwealth with
				  the liable employer, which the employee is capable of performing, the employer
				  shall offer that job to the employee prior to seeking a modification or
				  suspension of benefits based on earning power.
(b) The employer's obligation to offer a
				  specific job vacancy to the employee commences when the insurer provides the
				  notice to the employee required by section 306(b)(3) of the act (77 P. S. §
											512(b)(3)) and shall
				  continue for 30 days or until the filing of a Petition for Modification or
				  Suspension, whichever is longer. When an insurer files a Petition for
				  Modification or Suspension which is not based upon a change in medical
				  condition, the employer's obligation to offer a specific job vacancy commences
				  at least 30 days prior to the filing of the petition.
(c) The employer's duty under subsections (a)
				  and (b) may be satisfied if the employer demonstrates facts which may include
				  the following:
(1) The employee was notified
				  of a job vacancy and failed to respond.
(2) A specific job vacancy was offered to the
				  employee, which the employee refused.
(3) The employer offered a modified job to
				  the employee, which the employee refused.
(4) No job vacancy exists within the usual
				  employment area.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter D - EARNING POWER DETERMINATIONS › Section 123.302 - Evidence of earning power

Current through Register Vol. 54, No. 28, July 13, 2024
For claims for injuries suffered on or after June 24, 1996,
					 an insurer may demonstrate an employee's earning power by providing expert
					 opinion evidence relative to the employee's capacity to perform a job. The
					 evidence shall include joblistings with agencies of the Department, private job
					 placement agencies and advertisements in the usual employment area within this
					 Commonwealth. Partial disability applies if the employe is able to perform his
					 previous work, or can, considering the employe's residual productive skill,
					 education, age and work experience, engage in any other kind of substantial
					 gainful employment in the usual employment area in which the employe lives
					 within this Commonwealth. If the employe does not live within this
					 Commonwealth, the usual employment area where the injury occurred
					 applies.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter E - COLLECTIVE BARGAINING › Section 123.401 - Use of ADR systems

Current through Register Vol. 54, No. 28, July 13, 2024
CBAs may provide for the use of an ADR system which may
					 include arbitration, mediation and conciliation, for the resolution of claims
					 for work-related injuries.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter E - COLLECTIVE BARGAINING › Section 123.402 - Forms and filing requirements

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
				  If the employer and the recognized or certified and exclusive representative of
				  its employes agree to establish an ADR system, a copy of the portion of the CBA
				  which establishes the ADR system shall be provided to the Governor's Office of
				  Labor-Management Cooperation in the Department.
(b) The standard forms and filing
				  requirements of the act which reflect the voluntary action or agreement of the
				  parties remain in effect for parties participating in an ADR system under
				  section 450 of the act (77 P. S. §
											1000.6). The forms exclusively pertaining to
				  filings before a workers' compensation judge are inapplicable to parties
				  participating in an ADR system.
(c)
				  Documents submitted to the Department under this subchapter shall clearly
				  indicate, by notation on the top page of the document, that a section 450 ADR
				  system governs the disposition of the matter.
(d) Final determinations rendered by means of
				  an ADR system shall be documented and a copy of the determination shall be
				  submitted to the parties and to the Department.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter E - COLLECTIVE BARGAINING › Section 123.403 - Effect of creation, continuation and termination of ADR systems

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Once
				  established by a CBA, an ADR system shall be the exclusive system for resolving
				  claims for work-related injuries during the existence of the CBA or longer, if
				  the CBA provides for the continued operation of the ADR system at the
				  expiration of the CBA.
(b) When an
				  ADR system governing a work-related injury is no longer in effect, resolution
				  of claims shall be fully subject to the act, including review by a workers'
				  compensation judge.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter E - COLLECTIVE BARGAINING › Section 123.404 - Effect and appeal of ADR final determinations

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Final determinations rendered under an
				  ADR system are binding and enforceable.
(b) Appeals from determinations rendered
				  under an ADR system are limited to those made under the conditions specified by
				  42 Pa.C.S. §
											7314
				  (relating to vacating award by court).
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter F - EMPLOYE REPORTING AND VERIFICATION REQUIREMENTS › Section 123.501 - Reporting requirement

Current through Register Vol. 54, No. 28, July 13, 2024
An insurer shall notify the employe of the employe's
					 reporting requirements under sections 204 and 311.1(a) and (d) of the act
					 (77
					 P. S. §§
											71 and
					 631.1(a) and (d)). In
					 addition, the insurer shall provide the employe with the forms required to
					 fulfill the employe's reporting and verification requirements under section
					 311.1(d) of the act.
Pennsylvania Code › Title 34 - LABOR AND INDUSTRY › Part VIII - Bureau of Workers' Compensation › Chapter 123 - GENERAL PROVISIONS-PART II › Subchapter F - EMPLOYE REPORTING AND VERIFICATION REQUIREMENTS › Section 123.502 - Verification

Current through Register Vol. 54, No. 28, July 13, 2024
(a) Insurers may
				  submit Form LIBC-760, "Employee Verification of Employment, Self-employment or
				  Change in Physical Condition," to the employe and employe's counsel, if known,
				  to verify, no more than once every 6 months, that the status of the employe's
				  entitlement to receive compensation has not changed.
(b) Form LIBC-760 shall be delivered to the
				  employe in person or consistent with section 406 of the act.
(c) The employe shall complete and return
				  form LIBC-760 to the insurer within 30 days of receipt of the form.
(d) If the employe fails to comply with
				  subsection (c), the insurer may suspend payments of wage-loss benefits until
				  Form LIBC-760 is returned by the employe.
(e) To suspend payments of compensation due
				  to the employe's failure to comply with subsection (c), the insurer shall
				  provide written notice to the employee, the employee's counsel, if known, and
				  the Department, on Form LIBC-762, "Notice of Suspension for Failure to Return
				  Form LIBC-760 (Employee Verification of Employment, Self-employment or Change
				  in Physical Condition)" of the following:
(1)
				  The workers' compensation benefits have been suspended because of the
				  employee's failure to return the verification form within the 30-day
				  statutorily prescribed time period.
(2) The workers' compensation benefits shall
				  be reinstated by the insurer, effective upon receipt of the completed
				  verification form.
(3) The employee
				  has the right to challenge the suspension of benefits by filing a petition for
				  reinstatement with the Department.