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Pennsylvania Uninsured Employers Guaranty Fund v. Workers' Compensation Appeal Board (Lyle and Walt & Al's Auto & Towing Service)

Commonwealth Court of Pennsylvania

May 12, 2014

Pennsylvania Uninsured Employers Guaranty Fund, Petitioner
v.
Workers' Compensation Appeal Board (Lyle and Walt & Al's Auto & Towing Service), Respondents

Argued April 22, 2014

Appealed from No. A10-0808. State Agency: Workers' Compensation Appeal Board.

Carl J. Smith, Jr., Pittsburgh, for petitioner.

Eric P. Betzner, Washington, for respondent Russel J. Lyle.

BEFORE: HONORABLE ROBERT SIMPSON, Judge, HONORABLE ANNE E. COVEY, Judge, HONORABLE ROCHELLE S. FRIEDMAN, Senior Judge. OPINION BY JUDGE COVEY.

OPINION

Page 298

ANNE E. COVEY, Judge

Pennsylvania Uninsured Employers Guaranty Fund (the Fund) petitions this Court for review of the Workers' Compensation Appeal Board's (Board) July 23, 2013 order reversing the portion of the Workers' Compensation Judge's (WCJ) decision denying Russell J. Lyle's (Claimant) claim against the Fund as untimely. The issues for this Court's review are: (1) whether the Board erred by substituting its own factual findings; (2) whether the Board erred by holding as a matter of law that Claimant could not know Walt & Al's Auto & Towing Service (Employer) was uninsured until he received the Department of Labor & Industry's (Department) Bureau of Workers' Compensation (Bureau) notice; and, (3) whether untimely notice to the Fund should delay, rather than forever bar, Claimant's claim. We affirm.

The facts of this case are undisputed. Claimant was employed as a mechanic for Employer. On July 14, 2008,[1] Claimant suffered a compression fracture of his thoracic spine during the course and scope of his employment. As a result, Claimant sought medical treatment and was unable to perform his time-of-injury job. On September 26, 2008, Claimant filed a claim petition for his disability due to his July 14, 2008 work injury. Employer did not respond. Claimant attempted to have his medical bills paid through Progressive Insurance, Employer's automobile liability insurance provider, and then by Geico, Claimant's first party benefits automobile liability insurer, but both companies denied his claims.

By October 3, 2008 letter, the Bureau informed Claimant that Employer may not have workers' compensation insurance.[2] On October 7, 2008, Claimant mailed a Notice of Claim Against Uninsured Employer (Notice) to the Bureau. On October

Page 299

28, 2008, Claimant filed a claim petition with the Bureau seeking benefits from Employer and the Fund. The Fund filed an answer and new matter stating, inter alia, that the claim was barred due to Claimant's failure to comply with Section 1603(b) of the Workers' Compensation Act's (Act)[3] notice requirements.

Hearings were held before a WCJ on December 5, 2008[4] and January 13, April 21, May 26, August 27 and December 8, 2009. On April 27, 2010, the WCJ issued a decision granting Claimant's claim petition as to Employer,[5] but denying the claim petition as to the Fund because the Claimant did not give timely notice of his claim to the Fund. Claimant appealed to the Board which affirmed the WCJ's grant of Claimant's claim petition, but held that Claimant's notice to the Fund was timely and reversed that portion of the WCJ's decision.[6] The Fund appealed to this Court.[7]

The Fund first argues that the Board erred by substituting its factual findings for those made by the WCJ on the issue of whether Claimant timely notified the Fund of his claim. We disagree. Effective January 2007, Section 1602 of the Act, 77 P.S. § 2702, established the Fund for purposes of paying workers' compensation benefits and associated costs to claimants whose employers failed to be insured or self-insured for workers' compensation liability at the time their injuries occurred. In order for claimants to avail themselves of the Fund, Section 1603(b) of the Act provides:

An injured worker shall notify the [F]und within 45 days after the worker knew that the employer was uninsured. The [D]epartment [of Labor and Industry (Department)] shall have adequate time to monitor the claim and shall determine the obligations of the employer. No compensation shall be paid from the [F]und until notice is given and the [D]epartment determines that the employer failed to voluntarily accept and pay the claim or subsequently defaulted on payments of compensation. No compensation shall be due until notice is given.

77 P.S. § 2703(b) (emphasis added). Section 123.802 of the Bureau's Regulations likewise states:

Page 300

(a) . . . [A]n injured worker who seeks benefits from the Uninsured Employer Guaranty Fund (Fund) shall notify the Fund of a claim within 45 days from the date upon which the injured worker knew that the employer was uninsured.
(b) Compensation will not be paid from the Fund until notice is given.
(c) Notice to the Fund shall consist of completing and mailing the form designated as 'Notice of Claim Against Uninsured Employer' (Notice) to the Department of Labor and Industry (Department) at the address listed on the form. The Department may reject any incomplete Notice.
(d) The Notice will be deemed filed as of the date of the Notice's deposit in the United States Mail, as evidenced by a United States Postal Service postmark, properly addressed, with postage or charges prepaid. If a United States Postal Service Postmark is not present, the date of the Department's actual receipt of the Notice is the filing date.

34 Pa. Code ยง 123.802 (emphasis added). There is no dispute in this case that Claimant filed his Notice with the Fund within 45 days of receiving the Bureau's October 3, 2008 letter stating that Employer may not be insured. The issue, therefore, is whether that letter was the first point at which Claimant " knew that the [E]mployer was ...


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