COVID-19 Resource Center

July 27, 2008

Self Help: Legal Unilateral Benefit Modification

On many occasions, an injured worker will return to work but refuse to voluntarily sign a Supplemental Agreement to document the status of benefits. The Act provides a form of self-help for these situations in Sections 413(c) and (d). Section 413(c) applies where the injured worker returns to work at earnings that meet or exceed his pre-injury wages which would result in suspension of benefits. Section 413(d) applies where the employee returns to work at decreased earnings that would result in modification of weekly benefits.

Section 413(c) states: (c) Notwithstanding any provision of this act, an insurer may suspend the compensation during the time the employee has returned to work at his prior or increased earnings upon written notification of suspension by the insurer to the employee and the department, on a form prescribed by the department for this purpose. The notification of suspension shall include an affidavit by the insurer that compensation has been suspended because the employee has returned to work at prior or increased earnings. The insurer must mail the notification of suspension to the employee ant the department within seven days of the insurer suspending compensation.

(1) If the employee contests the averments of the insurer’s affidavit, a special supersedeas hearing before a workers’ compensation judge may be requested by the employee indicating by a check-off on the notification form that the suspension of benefits is being challenged and filing the notification of challenge with the department within twenty days of receipt of the notification of suspension from the insurer. The special supersedeas hearing shall be held within twenty-one days of the employee’s filing of the notification of challenge.(2) If the employee does not challenge the insurer’s notification of suspension within twenty days under paragraph (1), the employee shall be deemed to have admitted to the return to work and receipt of wages at prior or increased earnings. The insurer’s notification of suspension shall be deemed to have the same binding effect as a fully executed supplemental agreement for the suspension of benefits.

Section 413(d) is substantially similar to Section 413(c) but applies when the employee returns to work with a loss of earnings. LIBC-751 (Notification of Suspension or Modification Pursuant to §§413 (C) & (D)) is the designated Bureau form to take advantage of this provision. Advantages to utilizing LIBC-751 include situations where the injured worker refuses to voluntarily sign a Supplemental Agreement. The form may also be used in situations where the Insurer’s Affidavit goes unchallenged. In that case, LIBC-751 converts to a fully executed supplemental agreement and the burden then shifts back to the employee to file for reinstatement of benefits. 

What It Means to You

LIBC-751 is a relatively simple method to properly document the claimant’s benefit status and can have the effect of a Supplemental Agreement. The procedure is also a way to avoid penalties and shift the burden of proof back to the claimant if the claimant does not file a timely challenge within 20 days. Further information on Sections 413(c), (d) and form LIBC-751 can be answered by a Cipriani & Werner workers' compensation attorney.
 

Sources

Sections 413(c) and (d); 77 P.S. 774; LIBC-751