When you sustain a job injury or a work-related illness, the Pennsylvania Workers Compensation Act allows you to recover all of your related medical expenses and wage loss compensation for the money you lost if you are unable to work. If you sustain a work-related death, death benefits are then paid to dependent survivors.
Worker's Compensation benefits are paid by private insurance companies hired by your employer. There is also a state run workers compensation insurance company called the State Workers Insurance Fund (SWIF). Some employers are self insured and pay all Worker's Compensation benefits themselves.
Are you covered?
Almost every worker is covered under the Pennsylvania Worker's Compensation Act. All workers, including seasonal or part-time workers, are entitled to receive these benefits if they suffer a work-related injury. You are eligible for workers' compensation benefits on the very first day you are hired by the company. Your medical benefits are paid from the moment you suffer an injury. Your lost wages are paid tax-free at a rate called the compensation rate. There are formulas to determine what your compensation rate is and it depends on your average weekly wage or your salary.
How do I get benefits?
There are very strict time limits for reporting your work injury to your employer. You should report any injury or work-related illness to your employer or supervisor immediately. If you wait to report the injury, the employer may try to deny you benefits on the grounds that you were hurt outside of work. They may also try to question your credibility as to whether you were injured at work if you do not report it right away.
You should tell your employer that you were hurt at work, and inform your employer of the date you were injured and where you were injured.
You must report your injury to your employer no later than 120 days after the injury for Worker's Compensation benefits to be allowed. Further, unless your employer has knowledge of your injury within 21 days of the injury, no workers compensation benefits are due until you give the notice. If your request for Worker's Compensation benefits is denied by your employer or your employer's insurance company, you then have three years from the date of the injury to file a claim petition. In occupational disease cases, the injury or disability must occur within 300 weeks from the date of last employment in an occupation in which you had exposure to a hazard, and the petition must be filed no later than three years from the date of the injury or disability.
If you do not file the petition in a timely manner, you may be prevented from bringing a Workers' Compensation claim.
What are the types of benefits you can receive?
Payments for lost wages:
Wage loss benefits are available if it is determined that you are totally disabled and unable to work or partially disabled and receiving wages less than your pre-injury earnings.
If your injury results in death, your surviving beneficiaries may be entitled to benefits according to a specific formula under Worker's Compensation law. It is best to consult with an attorney to determine if you or your loved ones are entitled to benefits.
Specific loss benefits:
If you have lost the permanent use of all or part of your finger or thumb, arm, hand, leg, foot, toe, your eyesight, your hearing or you have a serious and permanent disfigurement or scar on your head, face or neck, you may be entitled to what is called a specific loss award. There is a formula for determining how much your benefits are depending on which part of your body is involved or how big your scar is or where it is located.
Your employer is responsible for advising you of your rights and duties under the Worker's Compensation Act. This is done by providing written notice in a public place at your work of the rights and duties that you have as soon as you become injured. If you do suffer a work-related illness or injury, you are entitled to the payment of all reasonable medical treatment provided by any healthcare provider. All of the prostheses, hospital care, medication, supplies, nursing is covered by your employer or their insurance company. Even if you do not miss any time from work, these medical expenses are paid through Worker's Compensation law. The medical provider cannot charge you the difference between what is paid by Worker's Comp. and what they typically charge. You should not owe any money for medical expenses. This means there is no co-pays or deductibles to pay for work-related medical treatment.
If your employer accepts your claim and has posted a list of six or more doctors or healthcare providers at your workplace, you are required to visit a doctor on the list for your initial treatment. You must continue treatment with the provider or someone else listed for a period of 90 days following the first visit. You can see any of the doctors listed and your employer may not require or direct you to see any specific provider on the list.
If you seek medical treatment from someone not on the list during the 90 day period your employer or your employer's insurance company may refuse to pay for that medical treatment. After 90 days, or in situations where your employer has not posted a list, you may seek treatment with any physician or other healthcare provider that you choose.
Total and partial disability benefits?
Total disability benefits:
These apply to injured workers for a period during which they are completely unable to work and are considered totally disabled. After you have received 104 weeks of disability benefits, the employer or their insurance company can require a medical examination called an IRE to determine if you are at least 50% impaired based upon your work injury according to the American Medical Association standards. If the 50% threshold is not met, then your employer can seek to change your benefits to partial disability.
Partial disability benefits:
This benefit will allow you to remain on partial disability for a maximum of 500 weeks. If your condition worsens and you obtain a qualified impairment of over 50%, you may file a petition to reinstate to total disability benefits. Being placed on partial disability benefits does not change the amount of your benefits check, it simply limits you to 500 weeks of total benefits.
How much are my benefit checks?
The amount you receive for wage loss is equal to approximately 2/3 of your average weekly wage, up to a maximum amount set by the state. Your wage loss benefits can be offset for 50% of Social Security benefits, any pension you are paid through a retirement, any unemployment compensation or severance pay. There is no cost-of-living increase under Pennsylvania Worker's Compensation law.
There are several different ways to calculate the average weekly wage. The minimum compensation rate is the lower of 90% of the workers average weekly wage or 50% of the statewide average weekly wage.
When are wage loss benefits paid?
You must be unable to work for more than seven (7) calendar days before workers compensation payments for lost time are payable. The benefits should be paid on the eighth day after the injury. If you have been off work for fourteen (14) days you should receive a back check for the first seven days.
Offer of employment?
Sometimes after you begin to receive benefits your employer will try to show that there is work available for you. They may file a petition and ask a workers' compensation judge to stop your benefits or reduce them based upon this employment. It is important that you contact an attorney right away if this happens to make sure your employer is not doing anything improper.
What if my employer wants to settle my case?
Your employer may decide to pay you a lump sum of benefits instead of continuing to pay you weekly lost wage and medical expense. There is a very complicated formula for determining what is an appropriate amount you should receive. It is extremely important you contact an attorney to assist you with any determination of the amount of a lump sum payment.