Workers’ compensation can be complicated in Pennsylvania, especially if you’ve never dealt with this system before. If you are ready to file a claim or have already filed a claim for workers’ compensation, it is natural to have a lot of questions. Some of the most common questions about workers’ compensation in Pennsylvania are covered on this page. Read on to find answers to your questions about coverage, eligibility, claims, payments, losing benefits, and medical concerns.
Questions About Coverage
Which injuries and illness are covered by workers’ compensation?
In Pennsylvania, the vast majority of injuries and illness that are caused through the course of employment will be covered by workers’ compensation, even when you are at fault for the injury. There are some injuries that are not covered, such as:
- Intentional injuries, self-inflicted (includes suicide)
- Injuries caused by your intoxication (alcohol or drugs)
- Injuries caused by physical attacks from co-workers (personal reasons)
- Injuries caused by physical attacks from others (not associated with workplace)
- Injuries caused by illegal acts
- Injuries caused in the course of commuting to or from work
Can I receive compensation for repetitive motion injuries (like carpal tunnel)?
As long as you can prove that the injury is work-related, you can receive compensation for injuries that result from repetitive motion, including carpal tunnel syndrome and other repetitive motion disorders.
Who provides workers’ compensation benefits?
In Pennsylvania, like most states, your employer is legally required to provide workers’ compensation coverage to all employees. If you are self-employed, then there may be an exception here. Unfortunately, just as many people break the laws requiring them to have car insurance, many employers neglect to carry workers’ compensation insurance.
Are part-time workers covered by workers’ compensation insurance in Pennsylvania?
Part-time workers are covered by the Workers’ Compensation Act, just as full time workers are. Some believe that if they are the only employee, their employer does not have to have workers’ compensation coverage. This is not true. The only time you may not be covered is if you are self-employed or if you employer unlawfully chooses not to have workers’ compensation coverage.
When am I covered by workers’ compensation at a new job?
Your coverage will begin on the same day that you start working at your new job.
Can I sue if my employer or co-worker caused my injuries/illness?
You cannot sue anyone for your work related injury or illness. You are only allowed to file for workers’ compensation to cover your medical expenses and lost wages. You will not receive compensation for pain and suffering for your injuries, and you cannot sue anyone unless the following exceptions apply:
Defective Product: If you sustained an injury or illness through a defective product, then you may be able to sue the manufacturer of that product for personal injury.
Physical Assault: If you sustained an injury or illness through physical assault from a co-worker, due to a personal matter, you may have a civil or criminal lawsuit against the co-worker.
Questions About Eligibility
How do I know if I’m eligible for workers’ compensation in PA?
You are eligible for workers’ compensation in PA when you meet the following criteria:
- You were hurt at work
- Your employment aggravated a pre-existing injury
- You developed an occupational illness
If you are injured while commuting to or from work or during a break, you are generally unable to receive workers’ compensation benefits for this.
What if I was injured during volunteer work?
Typically, you will not be eligible for workers’ compensation benefits when you are injured during the course of volunteer work. Some volunteers are exceptions, such as fire fighters, ambulance workers, school police, etc.
What if my injury was my own fault?
Even if your injury was your own fault, if it was work-related, you can still receive workers’ compensation benefits, as long as the injury was not intentionally self-inflicted.
What if my job requires travel and I was injured in an accident?
If you are on the clock while traveling, then you will be covered by workers’ compensation. Examples of workers that may be covered while traveling on the clock include traveling nurses and consultants and traveling sales personnel.
What if I was injured during my lunch break?
You will probably not be covered by workers’ compensation if you were injured during a lunch break or any other personal break during the workday.
What if my pre-existing condition was aggravated by work?
If you can demonstrate that your injury is new and related to your current employment, you can still receive workers’ compensation benefits. If the injury is not new, but is a recurrence of an old injury, then you may not be eligible for benefits.
What if I was injured at home while working for my employer?
This depends on whether it was your choice to take work home or if your employer asked you to do work at home. If the work at home was requested, you will probably be covered.
Questions About Claims
How much time do I have to file a workers’ compensation claim?
Immediately report any work-related injury or illness to your employer or supervisor. In Pennsylvania, you have 120 days to let your employer know that you suffered a work injury.
You should report your work-related injury to your employer/supervisor right away, though Pennsylvania allows you 120 days to do so. Your case will be stronger if you notify the employer as soon as possible. You will have three years from the date of the injury to file your claim.
What if I didn’t report my injury in time?
If you do not report your injury within 120 days, you lose your right to receive workers’ compensation.
What if I work in a different state, but live in Pennsylvania?
Your best bet is to find out if you can file for compensation payments in Pennsylvania before considering seeking compensation in the other state. This is because Pennsylvania has higher workers’ compensation payments than most other states. You can typically do this as long as you either work in Pennsylvania, live in Pennsylvania, or were hired by a Pennsylvania company. Every claim is different, so you’ll want to double check by seeking advice from an attorney.
What if my employer fired me for filing a workers’ compensation claim?
Your employer cannot legally fire you for filing a workers’ compensation claim. The employer will likely cite another reason for firing you, but if you suspect that it is related to your claim, you should contact an attorney to take further action to restore your benefits.
How do I know what to sign or avoid signing?
It can be confusing to know which forms to sign and not sign, because all forms from the Workers’ Compensation Bureau are the same color. Always read documents carefully before deciding whether or not to sign them. Remember that Pennsylvania courts will assume that you’ve read and fully understood any documents you’ve signed, and they won’t make exceptions for mistakes.
Use the following as a guide to deciding what forms to sign:
- Authorization for Medical Records – Do Sign – This form releases your medical records to the insurance company to review and process the claim.
- Employee Verification Form – Do Sign – This form must be completed and returned within 30 days of receiving it if you want to receive benefits.
- Supplemental Agreement – Be Careful – This form expresses that you can go back to work, though your claim is still open. However, it may also state that your benefits are being terminated. If you have not recovered from your injury, don’t sign.
- Final Receipt – Do Not Sign – If you have not fully recovered from your injury, do not sign this form. If you feel pressured to sign, contact an attorney.
Generally, if you are not sure about something, it is best to seek the advice of a Pennsylvania workers’ compensation attorney before signing anything.
What if my employer refuses to file a report for the injury?
You can always file a claim petition for your workers’ compensation payments if your employer refuses to complete an injury report on your behalf. You’ll have to attend a series of hearings with a judge, and you would be wise to have an attorney with you during these proceedings.
What if my workers’ compensation claim was denied?
If you were wrongfully denied workers’ compensation, you need to contact an attorney. However, there are many reasons for the claim to be denied. Whenever you think your claim has been wrongfully denied, an attorney can help you to address this situation.
What do I do if the workers’ compensation insurance company is following me, taking pictures, and talking to my friends and neighbors?
This is legal in Pennsylvania. Many workers’ compensation insurance companies will hire investigators to follow you around, take pictures, and talk to people who know you. They will also be able to use things against you that you post on social media, even if your privacy settings are strict. Anything on social media is considered to be public domain, so they can use these things against you. Having said that, if you are seriously injured with doctor’s orders restricting your activity, you shouldn’t have anything to hide or anything to worry about.
Questions About Payments
What types of payments will I get from workers’ compensation?
You can receive workers’ compensation payments in Pennsylvania whenever a doctor places you medical leave from work for more than one full week. You will receive payments for your first seven days of missed work when you’ve been under a doctor’s care and out of work for 14 consecutive work days. Once your claim for workers’ compensation is approved, you can receive payments for:
- Medical Benefits
- Lost Wages (Total or Partial Disability Benefits)
- Specific Loss Benefits
- Permanent Scarring or Disfigurement
- Hearing Loss
- Death Benefits
When can I expect to receive my first check from workers’ compensation?
The first check from workers’ compensation should come sometime after the first 21 days after informing your employer of the injury.
How much can I expect to receive for lost wages?
Payments for lost wages in Pennsylvania are about 2/3 of what your average weekly wage was prior to the injury. There is a pre-set maximum payment amount. In 2014, this amount was $932. You cannot receive more than the maximum amount in lost wages. Your payments for lost wages may be reduced by other sources of income, like a pension.
What if my employer filed a Petition to Terminate Compensation Benefits?
If your employer files a Petition to Terminate Compensation Benefits, this means that they believe you have recovered from your injury and can return to work. It will be up to a workers’ compensation judge to decide if your payments should stop. You will still receive your payments and benefits until the hearing takes place and the decision has been made. If you are still too injured to work, or if your doctor hasn’t released you for work, then you should contact an attorney if you receive this notice.
What if the workers’ compensation insurance company offers me a lump sum settlement?
You should never accept an offer for a lump sum settlement without first discussing your options with an attorney. You may lose all of your deserved workers’ compensation payments and benefits by accepting such a settlement without discussing it with an attorney first. In some cases, you can settle for a lump sum that is called a Compromise and Release. You can be eligible to do this when you’ve been out of work for more than four months because of an injury from work and you have already been receiving workers’ compensation benefits. Once you’ve accepted a lump sum settlement, you can no longer request further benefits, regardless of whether or not you are able to work. Learn more about lump sum settlements by contacting a Pennsylvania workers’ compensation attorney.
If I accept a light-duty job, will this affect my workers’ compensation payments?
Returning to work on a light-duty job can affect your workers’ compensation payments, though how it will affect them will be determined by how much money you make doing this work:
- If you make the same amount or more than before, lost wages payments will be suspended.
- If you make less money than before, you will receive partial disability benefits, which will equate to roughly 2/3 of the difference between your former and current wages. E.g. If you made $450/week before your injury, and make $300/week with your light-duty job, the difference is $150. You’ll receive 2/3 of that difference in partial disability payments ($100).
Keep in mind that your workers’ compensation benefits, including partial disability payments, cannot be greater than the maximum weekly payment that was set during the year of your injury. In 2014, this amount was $932 in Pennsylvania.
How can I pay my bills while I wait for workers’ compensation payments to begin?
It can be challenging to meet your financial responsibilities when you’re waiting for workers’ compensation payments to start coming in. Some options include:
- Use any vacation time or sick time that you have available.
- Seek public assistance.
- Find out if your employer has a sick/accident policy or disability policy.
Keep in mind that your workers’ compensation payments can be reduced based on income received through a sickness/accident/disability policy, public assistance, Social Security disability benefits, a pension, or unemployment compensation.
Questions About Losing Benefits
Should I be concerned about losing my Pennsylvania workers’ compensation benefits?
It is possible to lose your workers’ compensation benefits if you refuse to submit to reasonable medical services, if you refuse to comply with a medical exam order, if you are convicted of a crime and placed in jail, or if you fail to complete and return the employee verification form to the workers’ compensation insurance company within 30 days.
You can also lose your lost wage payments if a judge reviews the facts and determines that the payments should be stopped, if you have fully recovered from the injury and signed a Final Receipt (agreeing to stop your benefits), if you are assigned to a light-duty job that does not pay less than your usual wages, if you agree to a Compromise and Release lump sum settlement, or if you return to work making the same amount as or more than before.
There are also timelines to pay attention to. There is a 500-week limit for partial disability, and there are time limits set for specific loss payments, based on the nature of the injury. Your benefits will also stop if you die from a cause that is not related to the work injury. Any time you feel that you are in danger of losing your workers’ compensation benefits, you should contact an attorney for a free consultation.
How can I know if someone has filed a request to end my benefits?
You will know that someone has filed a request to end your benefits when you receive a Petition to Modify, Suspend or Terminate benefits. As soon as you receive this petition, you should contact a workers’ compensation attorney right away. There are strict deadlines for responding, and this isn’t something you’ll want to face without legal representation.
What if I’m not ready to return to work, but I’m being pressured/forced to do so?
Your employer should not attempt to pressure or force you to return to work if the company approved doctor has not cleared you to return. If the company approved doctor clears you to return to work, but your own doctor disagrees, then you can still refuse to return to work. A judge will review your case and any Petition to Terminate, Modify, or Suspend benefits must be approved before your benefits stop. You have a good chance of keeping your benefits if your doctor has not cleared you to work. However, if your personal doctor also thinks you can return to work, you are less likely to keep your benefits.
Do I have to accept a light-duty job offer that is different from my former job position?
You should accept any light-duty work that your employer offers that is within your medical restrictions. If you do not take the work, then you may lose your workers’ compensation benefits.
Questions About Medical Concerns
Do I have to see a company-approved doctor for my work-related injury?
Most employers will provide a list of company-approved doctors, and you do have to see one of these doctors within the first 90 days of your treatment. If you do not, then workers’ compensation may not cover your medical expenses. Once you see the company-approved doctor for the first time, you can choose your own doctor after 90 days. You will have to inform the workers’ compensation insurance company of who your new doctor is within five days of choosing one if you want to make sure that your expenses are covered. However, you may still have to see the company-approved doctor once every six months for the duration of your medical treatment. You also do not have to allow a representative of the workers’ compensation insurance company to be present for these examinations. In situations where the company you work for does not have a list of approved doctors, you can see any doctor you choose from the very start of your medical treatment.
What if the doctor releases me to light-duty work?
When a doctor releases you to light-duty work, you should accept any light-duty work that is offered by your employer, as long as it meets your work restrictions. If your employer does not have a light duty job available for you, then you can continue to receive benefits. If there is a light-duty job available, then you will receive partial disability benefits if it pays less than what you made before. Workers’ compensation will continue to cover your reasonable and necessary medical expenses related to the workplace injury. You can have your benefits started up again if you are laid off, if you are fired without cause, or if your doctor takes you back off of work.
What if I’m not ready to return to work, but my doctor says I am?
If your doctor says you are ready to return to work and no other doctor disagrees with this, then you can lose your workers’ compensation benefits if you do not return to work.
What if I have to travel to receive medical treatment for my work injury?
Typically, you will only receive reimbursement for medical appointments that are required by the employer or insurance company. You should always keep your receipts for parking and tolls and maintain a log of your mileage (including date and destination of each trip). If you are traveling to appointments that you have requested with your personal doctor, you will not be reimbursed.
What if my doctor says I cannot return to my original job and need retraining?
Your employer does not have to retrain you if you were injured at work.
When to Contact an Attorney
Whenever you have any questions or concerns about your workers’ compensation benefits or whenever you feel overwhelmed by the process and unsure of your next steps, this is the time to contact a Pennsylvania workers’ compensation attorney. You can get a free consultation and advice about your claim. This is the best way to move forward when you aren’t sure if you have a case or have any kind of questions about your workers’ compensation claim.