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Workers’ CompJeopardy
Making Workers’ Compensation Fun!
RETURN TO WORK EDITION
Hosted By: Edward R. Carpenter, Jr., Esquire
Distinguished Advisors: Christopher A. DiMeo, EsquireJeffrey S. Gross, Esquire The Honorable Andrea L. McCormick
JeopardyIT’S ALL IN
THE FORM
TIC TOC
OFFSETS AND
CREDIT
LABOR MARKET SURVEYS
HODGE PODGE
100 100 100 100 100
200 200 200 200 200
300 300 300 300 300
400 400 400 400 400
500 500 500 500 500
IT’S ALL IN THE FORMfor 100
This form must be sent before a job offer is made
To Answer
What is a Notice of Ability
to Return to Work?
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This form must be issued within seven (7) days of the change of benefits following the claimant’s return to work.
To Answer
IT’S ALL IN THE FORMfor 200
What is the LIBC 751 Notification of Suspension or Modification?
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This form can be used to obtain a voluntary suspension or modification of claimant’s benefits where the claimant returns to
work
To Answer
IT’S ALL IN THE FORMfor 300
What is an LIBC 337 Supplemental Agreement for Compensation?
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This form can be utilized to obtain information regarding a claimant’s earning capacity following a work‐related injury
To Answer
IT’S ALL IN THE FORMfor 400
What is an LIBC 750 and 760 form?
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DAILY DOUBLEEEEE
To Answer
IT’S ALL IN THE FORMfor 500
?????????????
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The period of time an employer has in which to issue a Notification of Modification or Suspension following an
injured worker’s return to work
To Answer
TIC TOC for 100
What is seven (7) days?
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The period of time in which an injured worker can challenge a Notification of Modification or Suspension
To Answer
TIC TOC for 200
What is twenty (20) days?
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The period of time a workers’ compensation judge must issue a Decision on a Challenge Petition
To Answer
TIC TOC for 300
What is within fourteen (14) days after Challenge Hearing?
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The period of time of temporary partial disability benefits an injured worker is entitled
to after return to work
To Answer
TIC TOC for 400
What is 500 weeks?
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The period of time in which an injured workers must complete and return the LIBC 760 form
To Answer
TIC TOC for 500
What is thirty (30) days?
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An employer is entitled to a dollar for dollar credit for these state benefits
OFFSETS AND CREDITfor 100
To Answer
What is Unemployment Benefits?
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This change of status may alleviate the necessity of making a job offer if the injured worker has voluntarily removed him/herself
from the workforce.
To Answer
OFFSETS AND CREDITfor 200
What is retirement?
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This type of payment to an injured worker may be applied as a credit to workers’ compensation benefits where the injured
worker is separated from employment
To Answer
OFFSETS AND CREDITfor 300
What is severance?
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TRUE or FALSE
Self‐employment earnings may preclude the payment of compensation benefits for wage loss benefits
To Answer
OFFSETS AND CREDITfor 400
What is True?
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This employer funded benefits will limit or preclude the receipt of workers’ compensation wage loss benefits
To Answer
OFFSETS AND CREDITfor 500
What is STD/LTD benefits?
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This document is required before any attempt at a job offer or labor market survey may be undertaken
To Answer
LABOR MARKET SURVEYSfor 100
What is a Notice of Ability
to Return to Work?
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TRUE OR FALSEAn employer is under no obligation to offer an injured worker a
job before a labor market survey can be performed
To Answer
LABOR MARKET SURVEYSfor 200
What is false?
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TRUE OR FALSEIn a labor market survey, jobs must remain
available until such time as the injured worker is afforded a reasonable opportunity to apply for
them
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LABOR MARKET SURVEYSfor 300
What is TRUE?
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TRUE OR FALSEIn determining earning power under a labor market survey, a workers’ compensation judge may choose any qualified position to determine post‐injury earnings.
To Answer
LABOR MARKET SURVEYSfor 400
What is TRUE?
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The percentage amount of wage loss benefits an injured workers entitled upon return to work with a loss of earnings
To Answer
LABOR MARKET SURVEYSfor 500
What is 2/3 of the difference of between average weekly wage and
actual earnings?
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This injured worker’s conduct may result in an employer’s action, which will preclude the payment of wage loss benefits
To Answer
HODGE PODGEfor 100
What is termination for cause?
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Membership in this organization may impact the ability of an employer to offer a job, and render an otherwise appropriate job
offer defective
• To Answer
HODGE PODGEfor 200
To Answer
What is union status?
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This employer action will not affect the entitlement to wage loss benefits for an injured worker who has returned to work in his
time of injury job.
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HODGE PODGEfor 300
What is a layoff?
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TRUE OR FALSEA labor market survey is not incompetent where a job listing does not meet the legal standard where
other jobs do meet the legal criteria.
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HODGE PODGEfor 400
What is TRUE?
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A return to work will reduce or preclude this scheduled worker’s compensation benefit
To Answer
HODGE PODGEfor 500
What is a healing period?
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