By Emily Brill
Filing workers’ compensation forms online can save attorneys headaches. But, as Pennsylvania lawyers have found out, it can create headaches, too.
A glitch in Pennsylvania’s online filing system has prevented some employers from properly notifying claimants of partial benefit denials, Philadelphia claimants’ attorney Maureen “Morty” Cassidy wrote in an article for The Legal Intelligencer posted online Thursday.
This is because when employers file a notice indicating their intention to stop paying indemnity benefits, Pennsylvania’s online filing system — the so-called Workers’ Compensation Automation and Integration System or WCAIS, pronounced “wick-us” — doesn’t generate a notice to claimants.
The system generates only a notice to claimants when employers stop paying both indemnity and medical benefits, Cassidy said.
But Pennsylvania law requires employers to notify claimants of any cessation in their benefits, so if workers don’t get that notice, employers technically aren’t in compliance with the law, Cassidy said.
The glitch came about in a recent update to WCAIS to accommodate the Electronic Data Interchange (EDI) Release 3, which came out in the summer.
WCAIS is updated frequently — at least every other month — and far from immune to glitches, though the Bureau of Workers’ Compensation usually fixes the bugs once it’s made aware of them, Philadelphia claimants’ attorney Jody Joy said.
Joy said she thinks of the glitches as something of a necessary evil: They’re bound to happen in any new technology, and overall, WCAIS has been good for Pennsylvania’s workers’ compensation system, she said.
Nonetheless, the glitches do cause hassle. Philadelphia defense attorney Wendy Smith said she’s familiar with the glitch Cassidy wrote about, and other problems with the system have resulted in her needing to send forms to the bureau manually.
“I had an issue with an employer because they were in between policies, and they didn’t have a particular carrier. It causes problems,” Smith said. “I call the bureau and tell them I’m going to have to file my docs by mail and get them out to the claimant so he can’t come back and hit me with a penalty petition, saying, ‘You didn’t pick up my claim in the time period required.’”
The Bureau of Workers’ Compensation has indicated that employers are responsible for sending out notices to workers regardless of issues with its online system, writing on its website, “Written notice to the injured worker has not changed due to implementation of EDI Release 3, and is still required.”
In the absence of an automatically generated form, employers and carriers can just send injured workers the partial-denial notice themselves, Pittsburgh claimants’ attorney Tom Baumann said.
“You’re dealing with sophisticated multi-billion dollar organizations. They should be able to handle it,” Baumann said. “How much do they need to be wet-nursed?”
If employers don’t send the form, that could end up being a good thing for a worker with attorney representation, because the attorney could argue that the denial never went into effect, and thus the client is owed more benefits, Baumann said.
“Some claimants can benefit by an employer’s negligence under those circumstances,” Baumann said.
Cassidy wrote that in her experience, employers who don’t send the notice have argued that “because the WCAIS does not allow them to do it, their actions are somehow warranted,” which has caused “a windfall of litigation.” She said that allowing an employer to “thwart a legal obligation” simply because of an issue with the technology isn’t right.
Smith said that WCAIS’ shortcomings are likely the result of the system being designed by an outside entity without legal experience. She said the system could use an overhaul to fix all the glitches in one go.
“Deloitte oversaw the project, but there’s a little bit of disconnect because they’re not the ones practicing law,” Smith said. “It’s a downside of technology.”
The BWC could not be reached for comment Thursday.
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