A Pennsylvania court has clarified when the state’s Uninsured Employers Guaranty Fund must pay workers’ comp claims involving out-of-state, uninsured employers - a key compliance issue.
On September 9, 2025, the Commonwealth Court of Pennsylvania issued its decision in a case involving Luis Aguilar, a roofer who suffered a spinal and hand fracture after falling from a roof while working for Life Time Home Improvement Contractors, LLC. Life Time is a New Jersey-based company that did not have Pennsylvania workers’ compensation insurance at the time of Aguilar’s injury.
Following his injury on March 30, 2022, Aguilar filed a claim petition, initially naming Joe Miller Construction Company as his employer. Joe Miller Construction denied that Aguilar was their employee. Aguilar then filed a claim for benefits from the Uninsured Employers Guaranty Fund, which is intended to provide compensation to workers injured while working for employers who do not have the required insurance coverage in Pennsylvania.
The Fund responded by filing a petition to join Life Time Home Improvement Contractors, LLC as an additional defendant, asserting that Life Time was Aguilar’s employer or, alternatively, his statutory employer. The Workers’ Compensation Judge (WCJ) reviewed the evidence and found that Aguilar was employed by Life Time, which had been subcontracted by Joe Miller Construction to perform shingle work. The WCJ also determined that Life Time was domiciled in New Jersey and lacked Pennsylvania workers’ compensation coverage on the date of the injury.
Based on these findings, the WCJ ruled that Life Time was responsible for Aguilar’s temporary total disability benefits. The Fund was found secondarily liable, but only if Aguilar could show he was not receiving or entitled to receive workers’ compensation benefits in New Jersey. This requirement is set out in Section 305.2(c.1) of the Pennsylvania Workers’ Compensation Act, which states that the Fund does not have to pay until the claimant submits proof - such as a written notice, denial, or ruling from the other state - showing ineligibility for benefits there.
The Fund appealed, arguing that Aguilar had not submitted the required proof before the close of the record. The Workers’ Compensation Appeal Board disagreed, noting that the statute does not specify a deadline for submitting this proof, only that payment from the Fund is contingent upon its submission. The Board’s interpretation was that the timing of the evidence does not affect the Fund’s liability, only the obligation to pay.
The Commonwealth Court affirmed the Board’s decision. The court emphasized that the statutory language conditions payment, not liability, on the submission of proof. The court declined to add requirements not present in the statute and noted that the Workers’ Compensation Act is remedial in nature and should be interpreted to benefit injured workers.
For insurance professionals, this decision underscores the importance of understanding how state funds operate when employers lack required coverage, especially in cases involving multiple states. The ruling offers practical guidance on statutory obligations and the timing of documentation in multi-state workers’ compensation claims.
Ultimately, the September 9 decision confirms that the Fund’s duty to pay is triggered by proof that the worker is not eligible for benefits in another state, not by when that proof is submitted during litigation. For the insurance industry, it’s a clear example of how courts are likely to interpret fund liability in cases involving uninsured, out-of-state employers, and it highlights the ongoing need for compliance with workers’ compensation requirements across state lines.
