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While we’re on the
topic of proper Plain Language Notice protocol, the Appeals Panel issued
Decision No. 230503 on June 12, 2023. The case involved an injured worker
who initially reported to his employer—in writing—that his injury occurred in
June 2022. The employer dutifully alerted its work comp carrier to the
injury once it was reported. The carrier, in turn, filed a PLN-1 denying
the claim in full within sixty days following notice.
Thereafter, the claimant asserted that he had been mistaken about the date of his injury, that it was not June 28 but rather July 28. The Division, operating under the assumption that this was an entirely different injury, generated a new DWC number for the ersatz second claim.
Claimant and his attorney argued that the carrier waived into accepting the July 2022 injury because no PLN-1 had been filed to combat it. The Administrative Law Judge agreed that the carrier accepted the claim via waiver, even after Claimant testified that he never sustained an injury in June, that he had mistakenly reported the incorrect date to his employer, and that the two dates of injury were actually one and the same.
The Appeals Panel reversed, reasoning that the carrier had disputed the claim when first alerted to it. “Under these facts, to require the carrier in this case to again dispute the injury it had previously disputed simply because the claimant alleged a different date of injury due to a typographical error would represent an elevation of form over substance.”
Copyright 2023, Stone Loughlin & Swanson, LLP