Frequently Asked Questions About Pennsylvania Workers' Compensation

Q: What is Workers' Compensation?

A: Workers' Compensation is insurance your employer must carry in the event an employee is injured on the job, becomes ill due to circumstances surrounding their job or even if death. Benefits include medical expenses, lost wages, specific loss benefits for amputation or loss of the use of an extremity, disfigurement benefits, and death benefits.

Q: Who provides the benefits under the Workers' Compensation Act?

A: By law the employer is responsible for providing Workers' Compensation Insurance. In some instances the employer provides benefits directly by being self-insured otherwise the employer provides the benefit indirectly through a Workers' Compensation insurance company. A worker cannot be charged for benefits provided or any portion of their employer's Workers' Compensation insurance premium.

Q: What are the rights and responsibilities of the injured worker?

A: An injured worker may be entitled to: receive wage benefits; receive medical care reasonable and necessary to treat a work-related injury or illness without any specific time limit; initially choose a doctor under certain circumstances; hire an attorney to help get benefits or to help resolve disputes; confidentiality. If you are injured, you may be responsible to: inform his or her employer about a work-related injury or illness; complete a claim form and submit it to the employer; tell his or her doctor how the injury occurred and if it was work related.

Q: What are the most important things an injured individual should know about workers' compensation rights?

A: Always report a work injury even if you might not lose time from work or need immediate medical care. It is critical that you require your employer to complete an accident report; Remember to keep an independent record of the date, time, and nature of your work injury. In addition, make a list of witnesses as well as the person to whom the injury is reported; Be sure to provide a complete and accurate account of the type of injury you sustained and how your injury occurred as well as your past medical history; If your employer fails to accept your claim within 21 days of the date you notify them, seek legal assistance and file a petition for compensation; Should your employer accept your injury, be certain that the wages upon which your compensation is based are accurate. In most cases your compensation should be 66 2/3% of your gross wages from all sources of employment; If, after receiving compensation, your employer or the insurance company asks you to see another physician, seek legal advice immediately as this is your employer's first step in their attempt to either terminate your compensation or modify your benefits; It is possible that your employer may offer you modified work based on medical proof that you are able to perform that work. This can cause you to lose your benefits by failing to accept the newly defined work; You might be contacted by a vocational rehabilitation firm attempting to find you a new job. Your compensation can be effected if you fail to cooperate with the vocational firm; Should you receive a petition in the mail to terminate, suspend or modify your compensation, seek legal advice; NEVER sign a supplement agreement or final receipt without having it reviewed by an attorney.

Q: What injuries are covered by the Act?

A: Any worker who has sustained an injury arising out of and in the course of their employment has a potential Workers' Compensation claim. As long as your injury is job-related, it's covered. You are covered if you are injured while traveling on business, doing a work-related errand or even attending a required business-related social function. Any injury or illness that occurs due to employment is considered a workers' compensation injury. Under workers' compensation law, you may receive benefits if you are injured no matter who was at fault. Some types of workers' compensation injuries are: broken/fractured bones, back problems/pain, knee problems/injuries, grip loss, heart attacks, hypertension, wrist injuries including carpal tunnel syndrome, burns, shoulder pain, neck pain, headaches, etc. You may be entitled to benefits even if you are still working.

Q: Does an injury have to have a specific date of onset in order to be covered?

A: Your injury does not need to be caused by a specific accident such as a fall. Many workers receive compensation for repetitive trauma injuries such as back problems that are caused by overuse or misuse over a long period of time in the performance of their normal work activity. You may also be compensated for some illnesses and diseases that are the gradual result of work conditions such as lung disease. Due to the fact that symptoms with these types of injuries reveal themselves over a period of time, the worker might not associate the eventual diagnosis of the injury as being work-related.

Q: What workers are covered by the Act?

A: Many states require an employer to carry Workers' Compensation insurance only if they have a minimum number of employees such as 3 or 5. As a general rule though, if a company has employees, then they should have Workers' Compensation insurance. Each state has its own workers' comp laws, as well as its own administrative and legal structure for handling claims and disputes. Some states also require workers' comp only for employees in "hazardous" occupations. What is considered a "hazardous" category can vary widely from state to state. Most employees are also covered if they are injured while working in another state or injured while working in another state for an employer whose principle place of business is in their home state. Without Workers' Compensation coverage, an employer can be sued by an injured worker for medical and disability costs, plus damages. Federal government employees are also excluded from state workers' compensation coverage. Employees of the federal government receive workers' compensation benefits under a separate federal law.

Q: What should I do if I get injured on the job?

A: Seek emergency medical attention if needed. Immediately report your injury to your employer. An injured worker must report any accident to their employer or any employee of the employer who is in a supervisory capacity (foreman, superintendent, company nurse, etc.). Notification must be done within a set amount of time as set by state law. If an injury occurs over time (for example, a breathing problem or carpel tunnel syndrome), you must report your condition soon after you discover and realize that it is caused by your work. Your employer will provide you with a claim form on which you must describe your injury and how, when, and where it occurred. Make sure you save copies of all correspondence with your employer, its insurance carrier and your doctor concerning your workers' comp claim.

Q: How long after an injury do I have to report it to my employer?

A: Immediately report your injury or illness to your supervisor. To be eligible for benefits, in Pennsylvania you must report the injury within 21 days. If you have received medical benefits, the statutory time limit to file a petition for benefits is usually three years from the date of the last payment [to file a claim for medical benefits]. If you have not received any medical benefits, the statutory time limit to file a petition is three years from the date of your injury or illness. Your employer is then required to make a report of the injury and notify its insurance company and/or the Workers' Compensation Commission. If no disability benefits are paid to the injured worker by the employer or carrier within the statutory time limit, and no petition is filed, then the right to any and all benefits may be barred.

Q: Can I lose my job because of a workers' compensation injury?

A: Laws prohibit your employer from discharging or discriminating against you because of your workers' compensation injury. If it is proven that an employer fires or forces you to resign in retaliation for filing a Workers' Compensation claim, the worker could file a civil lawsuit against his employer seeking damages in court.

Q: If I receive workers' compensation, can I also sue my employer in court?

A: Generally, no. In exchange for giving up the right to sue an employer in court, you get Workers' Compensation benefits no matter who was at fault. [You may be able to sue in court if your injury was caused by someone other than your employer or a co-employee, such as a visitor or outside contractor, some third party or if it was caused by a defective product.]

Q: What workers' compensation benefits am I entitled to?

A: You may be entitled to receive all reasonable and necessary medical treatment, benefits for lost wages, benefits for specific injuries resulting in permanent losses such as loss of use of an extremity and/or disfigurement (scars). You may also qualify to participate in certain physical and vocational rehabilitation programs. If the injury causes the death of an injured worker, burial expenses are covered and the spouse and/or dependents of the deceased worker may be entitled to certain benefits. If you become temporarily unable to work, you'll generally receive two-thirds of your average wage up to a fixed ceiling. These benefits are tax-free. You will be eligible for these wage-loss replacement benefits as soon as you've lost a set amount of work because of an injury or illness that is covered by workers' compensation as set by state law.

Q: What medical benefits does the Act provide to a worker after they have sustained an on-the-job injury?

A: An injured worker is entitled to receive 100% of all reasonable and necessary medical expenses incurred as a result of a job-related injury. These include first aid, emergency room services, inpatient and/or outpatient hospital care, doctor's fees, prescriptions and other related expenses.

Q: Should an injured worker apply for unemployment benefits?

A: In applying for unemployment benefits during the period a worker is off work due to an on-the-job injury, the worker must state in writing that they are willing and able to work. The Workers' Compensation insurance company could argue that the injured worker's statement to unemployment is contrary to their claim that they are unable to work. Recent court decisions have recognized the financial difficulties facing an injured worker who is not receiving Temporary Disability benefits under the Act and have ruled that a worker who has applied for unemployment benefits, in certain circumstances, is not barred from claiming they are entitled to certain workers' compensation benefits. It is advisable that an injured worker discuss the circumstances of their accident with a Workers' Compensation attorney before attempting to apply for unemployment benefits.

Q: If I am injured on the job can I choose the doctor who treats me?

A: Under Pennsylvania Workers' Compensation laws, the employer may restrict an injured worker's medical treatment, during the initial 90 days following an injury, to a set list of at least six medical providers. These providers are known as "panel providers." However, in order to compel an employee to treat with a panel provider, the employer must fulfill certain specific requirements [which are to]: Have a posted list or providers; and Have the employee sign an acknowledgement of receipt of the list at the time of hire and after the injury.

Q: If I am unable to return to the type of work I did before I was injured, what happens?

A: If your employer has employment available to you within your medical restrictions and you decline, your employer may request a suspension, modification or termination of your benefits. If you do return to work and wages are less than what you earned before the injury, you may be entitled to partial disability. Wage benefits usually will equal approximately 2/3 of the difference between your current earnings and what you earned before your injury, not exceeding the maximum compensation rate for the year you were injured.

Q: What happens if I return to a modified duty job and then I am laid off?

A: If you are still suffering from your work injury, you may be entitled to reinstatement to full disability.

Q: My employer has denied my claim, what do I do?

A: Immediately contact an attorney to discuss whether the facts of your circumstances entitle you to workers' compensation benefits. If so, a Claim Petition should be immediately filed on your behalf to obtain a hearing before a Workers' Compensation Judge.

Q: When is a Workers' Compensation claim considered settled and permanently closed?

A: A Workers' Compensation claim is considered settled only after a Compromise & Release Agreement is prepared and signed by both the employer and employee and approved by a Workers' Compensation Judge at a hearing.

Q: Do I need an attorney?

A: You have the right to be represented by an attorney for your work- related injury. Your attorney will assist you in seeing that your benefits are properly protected. While individuals can sometimes represent themselves in these matters, it is advised to contact a Workers' Compensation Attorney as soon as possible after an accident or diagnosis of a disease or condition in order to protect your legal rights. Workers' Compensation laws are constantly changing and an attorney will be in a better position to advise you in order to protect your rights.
Q: How do I find out my state's workers' comp requirements?

A: Since the state government sets Workers' Compensation requirements, they can vary greatly from state to state. You can consult the Pennsylvania Bureau of Workers' Compensation website or contact an attorney.