Frequently Asked Claims Questions
Liability
A: The member should immediately provide a copy of the lawsuit to PennPRIME and Inservco. We recommend to the member not to discuss the litigation with their staff or media. They should cooperate with all calls and letters from Inservco and your assigned attorney.
A: You will receive a call normally within 48 hours, however occasionally it may take 72 hours.
A: Yes. The claim information will be available through Inservco’s online Impyracle system in 48-72 hours.
A: Inservco will provide quarterly Status Reports that detail the status of the claim including the paid-to-date amounts, name of defense counsel, current litigation activities and recommended plans for future handling. Feel free to contact Inservco at any time with a question or comment you may have about your claim.
A: You can view your adjuster information via Impyracle or by calling Inservco at 800-356-0438 or 800-222-0355 for further information.
A: If you are sued, the legal complaint filed against you may state several different reasons for the lawsuit, some of which may be covered by your liability insurance policy and some of which may not be covered. PennPRIME provides a defense for you if any of the claims could be covered under your PennPRIME policy. A "Reservation of Rights" letter is a notice that even though PennPRIME is proceeding to handle your claim, depending on what happens, certain losses might not be covered by the terms of the policy.
A: PennPRIME has developed a relationship with a select group of highly competent defense attorneys who have a deep knowledge base of the relevant law applicable to any type of suit that may involve a municipal entity. These firms have sufficient highly skilled attorneys to ensure that your case is handled professionally in any legal forum, be it state or federal court. PennPRIME counsel has agreed to defense guidelines and standards with which they must comply to provide uniformly, cost-effective legal counsel, strategy and reporting.
A: PennPRIME and Inservco can provide guidance as to the best resolution of your claim but the best results are with your active cooperation. This includes ensuring that claims are timely filed with complete and accurate information. It is very helpful if you provide your Inservco claims adjuster with the names and telephone numbers of any contact persons at your municipal entity. You should encourage your contact persons and witnesses to be cooperative with our investigation, as well as providing timely and thorough responses to our inquiries. As additional information is available, it is important to keep PennPRIME and Inservco updated on new developments.
A: You may contact Inservco's Pyramid Help Desk at 800-356-0438 x 2021. Email contact may be made at pyramid@pnat.com.
Workers' Compensation
A:The answer depends upon whether the employer panel includes a provider who can provide the prescribed treatment. If it does, then the employee must obtain the treatment from that provider during the ninety-day period that the panel applies. If the panel does not include a provider who can render the treatment, then the employee will be directed by Inservco to a preferred provider who will provide the treatment.
A :The answer depends upon how long an employee is disabled. Under the Pennsylvania Workers’ Compensation Act, there is a seven (7) day waiting period for disability benefits.
- If the employee is disabled for eight (8) to thirteen (13) days, the payments begin with the eighth (8) day of disability.
- If the employee remains disabled for fourteen (14) days or more, then the disability payments begin with the first date of disability.
- All seven (7) days of the week are counted, whether or not the employee would be scheduled to work.
A: The first installment of compensation will be issued no later than 21 days from date disability began or the date the employer was notified of the injury, whichever is the latter.
A; Commuting to and from work is not in the course of employment, and therefore the employee would not be covered by workers’ compensation benefits, except in the following situations:
- The employee has no fixed place of work.
- The employment contract included transportation to and from work.
- The employee is on a special assignment for the employer.
- Special circumstances are such that the employee was furthering the business of the employer.
A: Returning to work has no effect on the medical benefits. Medical benefits continue as long as the treatment is found to be necessary, reasonable and related to the compensable injury.
A: Regular indemnity benefits are not taxable. However, if an employee receives interest payment(s), any such payment would be taxable.
A: Travel expenses for treatment that can be obtained locally are not reimbursable
A: For injuries that occurred on or after June 24, 1996, the employer can obtain an impairment rating evaluation at the expiration of 104 weeks of total disability. If the results of the examination indicate the employee is less than 50% impaired, the employee’s status can be converted to partial disability. Per the Act, partial disability benefits are limited to 500 weeks.