The Pennsylvania Supreme Court has concluded that an individual who is the sole owner and employee of a business is not required to provide his insurance carrier with notice of his work-related injury within 120 days to qualify for workers’ compensation benefits.
The state’s high court found that in cases involving an injured person who is a sole proprietor— both the owner and the employee— the 120-day notice requirement applies to notifying the employer, not the insurer. The court reversed a Commonwealth Court opinion that favored Erie Insurance and remanded the injury claim against Erie back to the Workers’ Compensation Bureau.
In its unanimous opinion, the high court said that if the plain language of the statute creates a problem, that is for the legislature to remedy, not the courts.
Competing Claims
The case involved David Heater, a sole proprietor and the sole employee of a one-man general contracting business. He says he was injured in 2015 while performing roof repairs when he allegedly fell from a ladder and fractured his neck, requiring immediate surgery. But his workers’ compensation insurer, Erie Insurance, did not receive notice of the injury until 2017, leading to a denied claim.
Erie claimed Heater did not injure himself while in the course of his employment but was instead injured when he attempted to perform a backflip while he was on a break. In its denial, Erie also claimed that Section 311 of the Workers’ Compensation Act requires that a claimant who is injured while working as an employee for his own solely-owned proprietorship provide notice of his injury to his insurer within 120 days of injury. It’s not uncommon for insurers to cite the 120-day notice requirement as a defense when sole proprietors delay reporting injuries.
Heater maintained that the plain language of Section 311 does not require him to provide notice of his injury to his insurer because the term “employer,” as contained in Section 311, does not include an insurer. He argued that a sole proprietor need only provide notice to his employer.
Reaching the High Court
It has taken 11 years since the alleged injury for the case to climb the judicial ladder and be decided by the Supreme Court. After this work incident in 2015, Heater filed a claim with the Pennsylvania Bureau of Workers’ Compensation in 2018. He sought total disability benefits as of the date he was injured, as well as payment of medical bills and counsel fees.
Erie opposed the claim, arguing that Heater was not injured within the scope of his employment; that the policy did not cover him as a sole proprietor; and that his claim was barred by the notice provision.
A workers’ compensation judge sided with Erie and found Heater was not eligible for compensation because he failed to provide notice to Erie within 120 days of his injury, which the judge said was required by Section 311. The judge cited the testimony of Heater’s insurance agent who had no recollection of Heater notifying him of the injury from his hospital bed as Heater claimed.
Heater appealed to the Workers’ Compensation Appeal Board, challenging the findings on the issue of notice, and asserting that because he was his own employer, employer’s notice of his injury was instantaneous. In January 2023, the appeals board reversed the workers’ compensation judge’s decision on the notice issue. It remanded the matter back to the workers’ compensation judge for a determination of whether Heater was injured during the course and scope of his employment. This time, the workers’ compensation judge granted Heater’s claim for disability benefits, finding he was injured during the course and scope of his employment.
Two Definitions
In analyzing Erie’s appeal, the Commonwealth Court acknowledged that the term “employer” is defined differently in two separate sections of the Workers’ Compensation Act. In one section the term includes insurer but in Section 311, the Commonwealth Court found the language to be ambiguous as to whom notice must be provided when the injured employee and the employer are the same. In a May 2024 ruling, the Commonwealth Court determined that the legislature intended that the term “employer” in Section 311 to include insurers.
In reversing that opinion on March 26, 2026, Supreme Court Chief Justice Debra Todd wrote that the Commonwealth Court incorrectly interpreted “employer” in Section 311 to include insurance companies. The Supreme Court found the statute is not ambiguous in defining “employer” as the business entity, not the insurance carrier.
Section 311 of the Act provides, in relevant part:
Unless the employer shall have knowledge of the occurrence of the injury, or unless the employe or someone in his behalf, or some of the dependents or someone in their behalf, shall give notice thereof to the employer within twenty-one days after the injury, no compensation shall be due until such notice be given, and, unless such notice be given within one hundred and twenty days after the occurrence of the injury, no compensation shall be allowed.
Lawmakers’ Job
The Supreme Court closed it opinion with a note on the concern expressed by the Commonwealth Court that applying the definition of employer that excludes insurers from the notice requirements, “creates a potential class of claimants, those who are sole proprietors and injured, who are not subject to forfeiture/loss of benefits provision of Section 311 for failing to give notice within 120 days of the injury,” thus allowing sole proprietors to “control the investigation of their own injury by delaying notice on the insurer until the last possible moment, . . . thereby defeating the purpose of this provision.”
The high court said the concern is not unfounded. However, such concerns “cannot override the plain language” of a statutory provision, or “contravene the plain meaning” of a term. Thus, “the task of rectifying perceived deficiencies in the statutory scheme” must be left to the legislature, the Supreme Court concluded.
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