How to Qualify for Pennsylvania Workers’ Compensation Benefits

Each year, almost 127,000 Pennsylvania workers experience non-fatal work injuries. Despite the large number, the majority of them may qualify for Pennsylvania workers’ compensation benefits. If you’re one of them, it’s important to retain a workers’ compensation lawyer to defend yourself and retain an adequate settlement.

In general, the system works well offering protections for employees and employers alike. However, it’s important to know the ins-and-outs of Pennsylvania workers’ comp if you’ve been injured or fall ill from work.

Keep reading to learn about Pennsylvania workers’ compensation laws, how you qualify, and when you need a lawyer’s help.

How Does Pennsylvania Workers’ Compensation Work?

Fortunately, nearly every employee in the state has insurance coverage thanks to the Pennsylvania Workers’ Compensation Act.

The “Act” — as it’s sometimes abbreviated — requires almost all Pennsylvania employers to provide workers’ compensation benefits for their employees.

That means any worker who suffers a work-related injury or illness qualifies for medical care coverage and lost wages. In return, the employee forfeits the right to sue their employer.

Workers’ compensation is mandatory for most employers in Pennsylvania. Those who don’t comply open themselves up for potential employee lawsuits and criminal prosecution.

Employers in Pennsylvania may obtain workers’ comp insurance in one of the following ways:

• By purchasing a policy from a licensed private insurance carrier
• By obtaining insurance from the State Workers’ Insurance Fund (SWIF)
• By applying with the Bureau Of Workers’ Compensation to self-insure their liability

Predicated on their condition, hurt employees may receive medical coverage and/or payments to make up for lost wages. In unfortunate cases where the worker doesn’t survive the incident, this insurance also covers death benefits.

Employees receive coverage for the entire period of their employment, which means from day-one on the job. The caveat is that they must qualify as an official employee in order to claim workers’ comp benefits.

Who is Eligible for Workers’ Compensation Benefits in PA?

Almost all employees will have coverage for work-related injuries and illnesses under Pennsylvania workers’ compensation. This includes:

• Part-timers
• Seasonal workers
• Non-profit organizations
• employers with one employee

As long as you fit the broad definition of an employee under Pennsylvania law, you’re covered by workers’ compensation. Also, remember that Pennsylvania workers’ compensation is a no-fault system. You may receive workers’ comp benefits, even if you were at-fault for your injuries, as long as they were work-related.

However, as always, there are a few exceptions to the rule. Generally, Pennsylvania employers don’t have to provide workers’ comp for:

• Individuals with coverage under other workers’ compensation acts, including railroad workers, longshoremen and federal employees.
• Agricultural employees working less than 30 days or earning less than $1,200 in a calendar year from one employer.
• Employees with approved exemptions due to religious beliefs or their executive status.

Others who may not qualify for coverage include volunteers, casual employees, and domestic workers. Sole proprietors with no employees are also off the hook when it comes to getting workers’ comp. However, they may elect coverage for themselves.

Injured workers who discover they do not have coverage may be eligible for benefits from the Uninsured Employer Guaranty Fund. For more details, call the Bureau of Workers’ Compensation, toll-free, at 1-800-482-2383.

Types of Injuries Covered By Pennsylvania Workers’ Compensation

Per the Pennsylvania Workers’ Compensation Act, there are no limitations on the type of injury or illness that is acceptable. The only requirement is that it absolutely has to have ties to your work or job. Meaning, it must happen during the course and scope of employment.

“(a) Every employer shall be liable for compensation for personal injury to, or for the death of each employe, by an injury in the course of his employment…”

–Section 301 of the Pennsylvania Workers’ Compensation Act

Accordingly, you may receive coverage for any number of conditions ranging from broken bones, to herniations and repetitive strain injuries. It may also cover illnesses that develop as a result of exposure to pollutants or toxins while on the job.

Occupational Diseases

Over time, the presence of hazardous materials in the workplace endangers the health and safety of employees.

Examples of this include the development of certain cancers due to asbestos, or radiation poisoning at a nuclear plant. Another occupational disease that’s more common in a state like Pennsylvania is black lung from coal mining.

Any worker developing one of these diseases directly resulting from their job will also be eligible for workers’ compensation benefits.

When Do I File My PA Workers’ Comp Claim?

The best practice for filing a PA workers’ comp claim is to do it right away.

That’s because unless they already know, it’s legally allowable for an employer not to pay benefits if you don’t notify them 21 days after the accident. At the latest, however, you must give notice within 120 days, or you forfeit your right to compensation.

With occupational diseases resulting from exposure to hazards, you have 300 weeks from the date of last employment for diagnosis.

If you want to file a legal claim, there is a three-year limit for filing legal claims from the date of illness or injury.

The most important thing to remember here, however, is that unless you put in your claim, you won’t attain coverage. So, the sooner you file, the faster you can receive the medical attention and lost wages you need.

Steps to Filing a Pennsylvania Workers’ Compensation Claim

In case of a work-related injury where there is immediate danger, the first step is always to call 911. It’s important to confirm your immediate safety right away. However, advise them that it’s a work-related injury and make sure to get copies of treatment records.

For less urgent injuries or illnesses, there is a certain protocol to follow. Here are the steps you should take to initiate a Pennsylvania workers’ compensation claim.

Step 1: Report the Case to Your Employer

Officially notifying your employer of your injury or illness is vital. In most cases, that means reporting it to your direct supervisor or manager.

Remember, though you technically have 120 days, you don’t want to wait. Report your work-related injury as soon as possible because you won’t get payments until you submit official notification.

Employers must also present such info on a Pennsylvania workers’ comp form LIBC-500. This form ensures that employees know the workers’ comp insurer for their company. It also spells out if there’s a third-party administrator or another person serving as their workers’ comp point of contact.

Step 2: Give Relevant Evidence

You’ll want to make sure you have pertinent evidence available when you make your report. You may also collect additional information as your claim and treatment progress.

As such, it’s important to keep records. Here is some information you may need to supply to your employer or workers’ comp insurance provider:

• What led to the injury or illness
• The date of the incident or realization of the condition
• When you made a report of your injury/illness to your employer
• When you first seek treatment
• Which body part(s) were involved, or the nature of your illness
• How much time you had to miss work as a result

Even if you don’t anticipate missing work because of your injury, keep track of these details for your workers’ comp attorney.

Step 3: Schedule Doctors Appointments

Pennsylvania workers’ comp laws allow you to see a physician of your choosing only in certain circumstances. As such, you must check with your employer before you get treatment.

Your employer may provide a list of six or more healthcare providers from which you may choose. If you seek treatment from an unlisted provider, it’s possible for your employer to refuse to pay your medical bills.

However, you may see any provider on the list for treatment and you must continue these selections for 90 days. After the 90 days, or if your employer doesn’t have a specific list, you may seek treatment elsewhere. However, you must give your employer and/or insurance notice of which healthcare practitioner you will be seeing.

How Much is My Pennsylvania Workers’ Comp Settlement Worth?

It is impossible to give a precise number estimating what your workers’ comp settlement may be worth. That’s because workers’ comp injury settlements vary from case-to-case depending on the severity of one’s losses.

However, there are a few guidelines of which you should be aware. To begin with, your potential earnings will depend on your degree of disability. There are different classifications of disability and they include:

• Temporary Total Disability (TTD). These are benefits that kick in when an employee is completely unable to work, but for a finite time period.
• Temporary Partial Disability (TPD). These benefits cover things like lost wages while an employee is recovering from an injury.
• Permanent Partial Disability (PPD). These benefits come into play when an employee suffers a permanent injury, but it only partially impairs their work ability.
• Permanent Total Disability (PTD). If a doctor determines that an injured employee can never return to work, then PTD benefits become available.

How Does Pennsylvania Calculate Workers’ Comp Lost Wages?

Depending on your degree of disability, wage-loss benefits may equal about two-thirds of your average weekly wage (AWW). However, that percentage of a person’s AWW is available only up to a weekly maximum.

Basically, an individual’s weekly Pennsylvania workers’ comp benefits falls into one of the following categories:

• Employee qualifies for and receives the maximum weekly 2024 compensation rate of $1,325.
• Employees whose average weekly wage is $993.76 to $1,987.50 receive a weekly compensation rate of 66.66% of their AWW.
• Employee receives a weekly compensation rate of $662.50 if the employee’s AWW is $736.11 to $993.75.
• Employee receives 90% of the AWW if his/her AWW is $736.10 or less.

As you can see, there are a lot of elements that go into calculating an individual’s workers’ comp rate. A workers’ comp attorney can help you sort through what your claim may ultimately be worth.

What Type of Workers’ Comp Settlement Should I Take?

Once you reach maximum medical improvement (MMI), or have permanent disability, the employer’s insurer may offer a settlement. Typically, this type of offer is put forth to “settle” the claim in order to close your case.

Pennsylvania workers’ comp settlements may take one of the two following forms:

• Compromise and release (CR). This is a one-time lump-sum settlement. If you take this settlement, you release your employer and insurer from paying any future benefits, even if your condition regresses. So, you should only sign a CR if you’re confident you reached maximum medical improvement.
• Structured settlement.  With this type of settlement, your lawyer negotiates a payment schedule where you receive a set payment at regular intervals. Also, if a condition requires ongoing care or therapy, a structured settlement may help cover those continued costs.

There are pros and cons to both types, and again your lawyer can help discern which is your best option. For now, just remember that with a CR, you can never reopen your claim. So, even though there is allure in receiving a big check, make sure you are confident in your recovery.

Can I Be Fired for Being on Workers’ Comp in Pennsylvania?

Though Pennsylvania is an at-will employment state, your employer cannot fire you explicitly for being on workers’ comp.

Even in states where someone can be fired for any reason, Pennsylvania laws explicitly protect disabled employees. If an employer fires a worker for bringing a legitimate workers’ comp case, the employee may sue for retaliation.

However, the employee’s claim must be valid for such a case to go forward. It is illegal to make a false workers’ comp claim just to get benefits.

What Happens if My Claim Was Denied?

If your Pennsylvania workers’ comp claim was denied, you still have options to appeal. However, the first thing to consider is why your employer or their insurer issued their denial.

For example, injuries that happen at work that aren’t job-related may not receive approval. Other common reasons for denial include that the injury was:

• Self-inflicted or intentional
• Due to horseplay or fighting
• A result of being under the influence of drugs or alcohol
• In violation of company policy

An employee should see the reason for their rejection when they receive a Notice of Workers’ Compensation Denial (LIBC-496).

If you disagree with your claim’s determination, you do have the right to contest it by filing a petition. However, you’ll want to retain a lawyer before entering an appeal owing to the complexity of these cases.

Can I Sue While on Workers’ Comp?

Recall that if you accept workers’ comp benefits, you do so in exchange for not suing your employer. The system is set up to keep employees and employers out of messy personal injury lawsuits following work-related injuries.

However, if you’re hurt at work and your employer doesn’t have the proper workers’ compensation insurance, you may sue. You may also bring cases against third parties, like other employees who contributed to your work-related injury.

Find a Pennsylvania Workers’ Comp Attorney with LegalASAP

Pennsylvania workers’ compensation law is very complicated and it’s difficult to get the full benefits you deserve by yourself. Especially since your employer and their insurer will absolutely have a lawyer working for them.

Instead of entering into these negotiations at a disadvantage, let us help connect you with a lawyer in your area. The good news is that workers’ comp attorneys work on a contingency basis. So, you won’t have to pay anything out-of-pocket for legal services if you qualify for a claim.

Plus, having a skilled workers’ comp attorney in your corner will likely result in a larger settlement. Schedule a free consultation today, so you can get back in action as soon as possible.