§ 121.1. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Act—The Workers’ Compensation Act (77 P.S. § § 1—1041.4 and 2501—2506).
Agreement—For purposes of this chapter, an agreement is limited to any of the following:(i) Agreement for Compensation for Disability or Permanent Injury, Form LIBC-336.
(ii) Supplemental Agreement for Compensation for Disability or Permanent Injury, Form LIBC-337.
(iii) Agreement for Compensation for Death, Form LIBC-338.
(iv) Supplemental Agreement for Compensation for Death, Form LIBC-339.
Approved rating organization—One or more organizations situated within this Commonwealth, subject to supervision and to examination by the Insurance Commissioner and approved by the Insurance Commissioner as adequately equipped to perform the functions specified in Article VII of the act (77 P.S. § § 1035.1—1035.22) on an equitable and impartial basis.
Board—The Workers’ Compensation Appeal Board.
Bureau—The Bureau of Workers’ Compensation of the Department.
Claimant—An individual who files a petition for, or otherwise receives, benefits under the act or the Disease Law.
Department—The Department of Labor and Industry of the Commonwealth.
Disease Law—The Occupational Disease Act (77 P.S. § § 1201—1603).
Earned premium—A direct premium earned as required to be reported to the Insurance Department on Special Schedule ‘‘W,’’ under section 655 of The Insurance Company Law of 1921 (40 P.S. § 815). For the purposes of this chapter, direct premium earned may not include:(i) The effects of premium credits granted under deductible elections by insured employer.
(ii) Premiums not attributable to coverage under the act or the Disease Law.
(iii) Premiums attributable to excess policies written for specified retentions on self-insured employers.
Employer—As defined in section 401 of the act (77 P.S. § 701), including the insurer and a self-insured employer.
First report of injury—A filing made with the Bureau under section 438 of the act (77 P.S. § 994).
Insurance carrier—An entity or group of affiliated entities subject to The Insurance Company Law of 1921 (40 P.S. § § 341—477d), including the State Workers’ Insurance Fund, but not including self-insured employers or runoff self-insurers, with which an employer has insured its liability under section 305 of the act (77 P.S. § 501).
Insured employer—An employer which has chosen to insure its workers’ compensation liabilities through a workers’ compensation insurance carrier licensed to do so in this Commonwealth, including the State Workers’ Insurance Fund.
Insurer—(i) A workers’ compensation insurance carrier which is licensed to insure workers’ compensation liabilities in this Commonwealth and acts in this capacity on behalf of insured employers.
(ii) The term includes a self-insured employer and a runoff self-insurer.
Runoff self-insurer—An employer that had been a self-insurer but no longer maintains a current permit to self-insure under section 305 of the act (77 P.S. § 501).
Self-insured employer—(i) An employer which has been granted the privilege to self-insure its liability under the act.
(ii) The term includes a parent company or affiliate which has assumed a subsidiary’s or an affiliate’s liability upon the termination of the parent-subsidiary or affiliate relationship, and a runoff self-insurer.
Special funds—Funds maintained under sections 306.2, 443 and 446 of the act (77 P.S. § § 517, 999 and 1000.2).
Authority The provisions of this § 121.1 amended under section 2218 of The Administrative Code of 1929 (71 P.S. § 578).
Source The provisions of this § 121.1 amended May 14, 1999, effective May 15, 1999, 29 Pa.B. 2649; amended August 3, 2007, effective August 4, 2007, 37 Pa.B. 4181. Immediately preceding text appears at serial pages (294658) and (324967).
Notes of Decisions Insured Employer
Employer met its obligation to provide payment for claimant’s medical treatment by contracting with insurance company to assume direct responsibility for payment of claimant’s medical bills. Insurer was placed into liquidation and responsibility for paying workers’ compensation passed to the Workers’ Compensation Security Fund. Therefore, employer could not be assessed a penalty for Security Fund’s failure to pay medical bills in a timely manner because there was nothing to suggest that the delayed payment was attributable to employer. Constructo Temps v. Workers’ Compensation Appeal Board (Tennant), 907 A.2d 52, 59, 60 (Pa. Cmwlth. 2006).
Medical Benefits
Neither the private insurer defendants nor the school district defendants are State actors primarily because the decision to cease paying medical benefits is entirely up to the insurer acting independent of any State involvement whatsoever. The States takes no substantive step to promote, support or encourage the decision of the insurer, and after the decision is made, the State takes no action which influences the ultimate substantive determination as to whether benefits are payable or not. The State does not significantly assist private actors when it merely provides a remedy, albeit complete with authorized forms and regulations. The State’s acceptance and routing of forms completed in accordance with its instructions, in essence, involves acquiescence and not compulsion on the part of the State. Sullivan v. Barnett, 913 F. Supp. 895 (1996); reversed 139 F.2d 158 (3rd Cir. 1998); reversed 526 U. S. 40 (1999).
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