Claims for Compensation

CLAIM FOR COMPENSATION / A DWC-1 Does Not File A Claim For Compensation For Claimant / ALJ Failed To Make Findings On Good Cause For Late Filing

Appeal 190915

            The claimant was a funeral director.  He was injured when he tripped over a parking barrier while carrying a display of flowers, falling to the ground onto his left knee.  He kept working with a knee support sleeve.  Almost a year later, the claimant went on vacation with his wife and developed pain in his knee from walking.  An MRI revealed a medical meniscus tear in the left knee.  That’s when he decided to pursue a claim.  The employer filed a DWC-1 within one year of the date of injury, but the claimant’s DWC-41 was after the one year deadline.

            The discussion of the case indicates a PLN-1 was filed that recognized a work event had occurred, but denied any resulting injury.  Regardless, the issue of whether the carrier was relieved of liability due to the claimant’s failure to file a claim for compensation within one year was certified at the BRC.  The claimant failed to raise an issue of carrier waiver of the carrier’s defense. 

At the CCH, the ALJ determined that a claim for compensation was filed within one year because the employer filed a DWC-1 and that put the Division and carrier on notice.  The ALJ also determined, after adding the issue after the CCH, that the carrier waived its right to deny the claim using the one year deadline as a defense because waiver was “actually litigated” by the parties.

The AP reversed the waiver decision.  No party raised the issue of waiver of the one-year limitation defense, and it was not litigated.  Furthermore, a DWC-1 is not a claim for compensation because there was no evidence that the employer filed the DWC-1 “on behalf of the claimant.”  Additionally, now that there is a decision that the claimant did not file a claim for compensation within one year, there must be a finding of whether or not the claimant had good cause for failing to file within one year before a decision can be made on whether or not the carrier is relieved of liability.