EMPLOYEE VERIFICATION OF EMPLOYMENT, SELF-EMPLOYMENT, OR CHANGE IN PHYSICAL CONDITION
Form LIBC-760, the Employee Verification of Employment, Self-Employment or Change in Physical Condition, is the most important form to get back to the insurance company within 30 days or you may end up having you benefits suspended if you miss the deadline.
Unlike other information, if you become employed or self-employed, you are supposed to report this to the insurance company as soon as possible, but no later than 30 days after employment or self-employment begins. You also must cooperate with the insurer in any investigation of employment, self-employment, wages and physical condition.
Both the "Employee Verification of Employment, Self-Employment or Change in Physical Condition" and the "Employee Report of Wages and Physical Condition" ask if your physical condition caused by your work injury has changed. The Workers' Comp Act does not provide much guidance for what constitutes a "change." In general, unless there has been a significant change in your physical condition, you should just mark no.
Question 5 asks if there is other information that you are aware of "that is relevant in determining your entitlement to, or amount of compensation." The Workers' Compensation Act does not provide much guidance as to what information this could be. If you know, however, that you have received a benefit for which the insurance company is entitled to an offset, you should note that in the section marked: "If yes, please explain:" If the insurance company sent you an "Employee's Report of Benefits for Offsets" at the same time that it sent you an Employee's “Report of Wages and Physical Condition”, in the section marked "if yes, please explain:" write “See Employee's Report of Benefits for Offsets.”
EMPLOYEE REPORT OF WAGES AND PHYSICAL CONDITION
Possibly the silliest of all forms is the Employee Report of Wages and Physical Condition, which requires you to report the same information contained in the "Employee Verification of Employment, Self-Employment, or Change in Physical Condition."
Question 4 asks you whether your physical condition caused by your work injury has changed. Unlike Form LIBC-760, described above, this form requires you to attach a medical report if you respond yes. Because it is much more important to get these forms back to the insurance company within 30 days, if you cannot obtain a supporting medical report, send the form back to the insurance company without the report.
EMPLOYEE’S REPORT OF BENEFITS FOR OFFSETS
The Employee's Report of Benefits for Offsets is designed to gather information concerning unemployment compensation, Social Security Retirement, severance, and pension benefits, for which the employer or insurance company is entitled to . Let's look at the types of benefits described in the form in the order they appear.
• Unemployment Compensation
It is common for people to believe that they may not collect unemployment compensation benefits if they're entitled to receive workers' compensation benefits. If you are receiving workers' compensation benefits, it makes no sense to apply for or receive unemployment compensation benefits, because the workers' compensation insurance company is legally entitled to reduce your workers' compensation benefits by an amount equal to your net unemployment compensation benefits. If, however, your claim is denied and you are pursuing an appeal, you may be entitled to collect unemployment compensation benefits under certain circumstances. If you are physically capable of working at a lighter-duty job than the one you were performing at the time of injury and your employer does not have such work available, you are entitled to receive unemployment compensation benefits. If you are totally disabled from all employment, you are not entitled to receive unemployment compensation benefits. (This makes no sense, but it is the law).
If you are awarded workers' compensation benefits, the insurance company is entitled to reduce your workers' compensation benefits by an amount equal to the net (after tax) unemployment compensation benefits you receive. It is probably best to think of unemployment compensation benefits you receive under these circumstances as an advance payment of workers' compensation benefits.
When you applied for unemployment compensation benefits, you should have been given a PIN number to access information concerning unemployment compensation benefits from the website, which can be accessed here. It is important to make sure that you fill in the net amount of unemployment compensation benefits you receive, or the insurance company will use the gross figure, which does not include deductions for taxes.
• Social Security (Old Age)
The insurance company is entitled to an offset equal to 50 percent of your net (after tax) Social Security retirement benefits only if you commenced receiving them after the work injury occurred. Again, you want to make sure that you fill in the net portion so that they will not attempt to take 50 percent of your gross (before tax) benefits. This section is not asking you to provide any information concerning Social Security Disability benefits.
Your employer may have terminated your employment following your work injury. Sometimes they will provide you with a severance payment. The insurance company is entitled to an offset for net severance benefits. As a practical matter, you should not accept severance benefits without consulting a lawyer, particularly if you are being asked to give up certain rights in return for the payment of such benefits. Because the insurance company is going to get a credit for the net severance benefits you receive, it makes little sense for you to give up any rights you may have when you are not going to ultimately receive any of the money that is paid to you.
• Pension Benefits
The insurance company is entitled to an offset for pension benefits to the extent that those pension benefits were funded by the employer directly liable for your workers' compensation benefits. Accordingly, if you are receiving a pension for a position that you held with a different company before the injury occurred, they are not entitled to an offset for those pension benefits.
It is possible that you funded your pension partially or entirely. Because the insurance company may reduce your benefits only to the extent funded by your time-of-injury employer, they cannot reduce your benefits to the extent that you funded them.
The general rule is that if you paid your pension contributions in after tax income, you funded the pension. If the pension contributions were made before taxes were deducted, your employer funded the pension. The issue is a bit more complicated than that, but you need to be very careful in reporting pension benefits or you will find that the insurance company will take an offset for pension benefits that they are not entitled to receive.
If you do not know the percent of the pension funded by the employer, make sure you check the “percentage unknown” block.
Pension benefits can be rolled over into an IRA account. To the extent that the employer responsible for payment of compensation funded the pension, the insurance company is still entitled to an offset for your pension even after it is rolled over into an IRA account, though there is no offset until you begin withdrawing from your account.
Any person collecting Pennsylvania workers’ comp benefits who is considering retiring should be very careful before doing so. In almost all circumstances, you should consult an attorney. If you retire after you suffer a work injury, this may preclude you from obtaining a reinstatement of workers' compensation benefits. Furthermore, though a forced retirement is not considered a withdrawal from the workforce, there are circumstances under which a retirement can be considered a withdrawal from the workforce for reasons unrelated to the work injury, in which case you may end up losing your workers' compensation wage loss benefits.
• Wages From Employment or Self-Employment
The last box on the form requires you to check a box if you are receiving any wages from employment or self-employment. Self-employment wages should be reviewed with an attorney. Receiving rent on a rental property, for example, does not constitute wages.
If you receive benefits in excess of your weekly workers' compensation rate, those benefits accumulate as a credit toward the future payment of workers' compensation benefits. For example, if you received a net severance benefit of $7,000.00, and your weekly compensation rate is $500.00, the insurance company is entitled to stop paying you workers' compensation benefits for a total of 14 weeks (weekly severance offset $500.00 times 14 equals $7,000.00). If you received unemployment compensation benefits or pension benefits dating back to an earlier period of time after the injury occurred, the insurance company will be entitled to an offset for benefits you've already received.
The insurance company is not entitled to take an offset for unilaterally. The insurance company must provide you notice at least 20 days prior to taking the offset to give you the chance to challenge the amount and basis for the offset. Furthermore, the insurance company must exercise reasonable diligence in investigating and acting on entitlements to offsets other than wage offsets. If they send you reporting forms every six months, this is considered reasonable diligence and the insurer will be permitted to recoup overpayments in full. If they fail to send reporting forms for an extended period of time, they may be barred from recovering past overpayments, particularly if this would cause hardship.
The workers’ comp insurer may not take an offset for benefits you may be eligible for, but are not receiving. For example, if you are entitled to collect a pension, but you have elected not to collect it, the insurance company has no right to take an offset.
You may want to defer receiving pension benefits or Social Security retirement benefits because you may be entitled to receive greater benefits if you defer payment. This is true of some pension benefit plans and is true of all Social Security retirement benefits. Furthermore, it may make sense to defer receiving benefits and attempt to resolve your workers' compensation case for a lump sum before you begin collecting benefits that may entitle the insurance company to a substantial offset.