An order denying claim made against Uninsured Employers Guaranty Fund based on untimely notice was properly reversed when evidence showed that claimant did not know of employer’s uninsured status until being notified of that possibility by the Bureau.

The claimant worked for the employer as a mechanic and sustained a compression fracture injury in the course and scope of his employment. The claimant filed a claim petition, and the employer did not respond. The claimant attempted to have medical bills paid through the employer’s automobile liability insurance provider and then through the claimant’s first party benefits automobile liability insurer, but both companies denied his claims. Thereafter, the Bureau informed the claimant by letter that the employer may not have had workers’ compensation insurance. Four days after receiving this letter, the claimant mailed a Notice of Claim Against Uninsured Employer (notice) to the Bureau. Twenty-five days after the letter, the claimant filed a claim petition with the Bureau, seeking benefits from the employer and the Uninsured Employers Guaranty Fund (Fund). The Fund challenged the petition and took the position that the claim was barred due to the claimant’s failure to comply with the notice requirements for making a claim against the Fund.

The Workers’ Compensation Judge granted the claim petition filed against the employer, but denied the claim petition filed against the Fund on the basis that the claimant did not give timely notice to the Fund. On appeal, the Appeal Board reversed the dismissal of the claim against the Fund, holding that notice was timely. The Fund appealed to the Commonwealth Court.

The court noted that the claimant filed his notice with the Fund within 45 days of receiving the Bureau’s letter stating that the employer may not be insured. The court found that this was compliant with §1603 (b) of the Act, which provides that an injured worker shall notify the Fund within 45 days after the worker knew that the employer was uninsured. The question for the court was whether the letter was the first point at which the claimant knew the employer was uninsured. The Judge found that the claimant knew of the employer’s uninsured status before receiving the letter from the Bureau. The Commonwealth Court held otherwise. In the Commonwealth Court’s view, the Board properly reasoned that §1603 (b) of the Act is triggered when a claimant “knew” rather than “should have known.” The court pointed out that when the claimant learned medical bills were not being paid, he notified the employer, who repeatedly assured him that the problem was being investigated. In addition, when the payment of the claimant’s medical bills was denied by the employer’s automobile liability insurance carrier, there was no indication in the letter denying the claim that the medical bills would be covered under the employer’s workers compensation insurance, nor did it state that the workers’ compensation coverage had lapsed. The court, thus, held that the Judge’s finding that the claimant had knowledge of the employer’s uninsured status months before receiving the letter from the Bureau was not supported by the evidentiary record and, therefore, concluded that the claimant gave timely notification to the Fund.

Case Law Alerts, 3rd Quarter, July 2014