Benefits in Pennsylvania

According to the PA Dept. of Labor approximately 85,000 people are injured each year, on the job in Pennsylvania. Pennsylvania's worker's compensation laws entitle you to receive medical expenses and lost wages when you suffer a work-related injury or contract a disease which is aggravated by the work you perform. Survivors of someone who has died in a work-related accident, may also be entitled to benefits.

Workers injured while on the job in Pennsylvania enjoy certain rights under the law. Generally, they are entitled to full medical care by health care providers of their choice, and to indemnity benefits which compensate for lost income for those permanently or temporarily disabled.

To receive workers compensation, "work comp." benefits, you must inform your employer:

1. That you were injured while working.
2. The exact date of the injury.
3. The location of injury.

In Pennsylvania, you are covered by worker's compensation from the first day of work and through the duration of your employment. Self-insured employers or service companies investigate and make decisions to accept or deny an individual's claim. In other words, your employer's insurance company will make the initial decision on whether your injury is covered under the Pennsylvania Worker's Compensation Act.

If your workers' compensation claim is denied, you are entitled to file a Claim Petition with the Pennsylvania Department of Labor and Industry. The Petition will be assigned to a workers' compensation judge who will conduct a hearing to receive testimony and medical evidence to substantiate your claim. Based on the information presented at the hearing, the judge will make a determination regarding your eligibility to receive workers' compensation benefits.

Your wage loss benefits for a total disability status are equal to approximately 2/3rds of your average weekly wage up to a weekly maximum. Benefits for partial disability are paid at injury wages and are reduced by approximately 2/3rds the difference between pre-tax wages, again up to a weekly maximum. Wage loss benefits for injuries can be offset on or after June 24, 1996 for 50% of Social Security benefits; the employer paid portion of a retirement pension; and the employer paid portion of a retirement pension and service by benefits can also be offset for unemployment compensation or any earnings you may receive regardless of the date of injury. Injured workers are also entitled to medical expenses for treatment which are related to the work injury, and which are reasonable and necessary.

In seeking medical treatment for your work-related injury, you must find out if your employer has posted a list of physicians or health care providers in your work place. If the employer has done this, then you are required to visit one of them for initial treatment. You are to continue treatment with that provider or another on the list for a period of 90 days following the first visit. If your employer's health care provider prescribes invasive surgery, you are entitled to a second opinion which will be paid for by your employer/insurer. Treatment recommended as a result of the second opinion must be provided by a list provider for 90 days. After the 90 days in cases where there is no list of providers, you may treat with any provider you like. You are required to notify your employer of the provider you have selected.

There are time limits for filing a claim. You must notify your employer of your injury or illness within 120 days. If the claim is denied by your employer/insurer, then you have three years from the date of the injury to file a Claim Petition for a hearing and a determination by a workers' compensation judge. In occupational disease cases, the disability must occur within 300 weeks from the date of last employment in an occupation where you had exposure to a hazard, and a Claim Petition must be filed no later than three years from the date of the injury and disability. If your benefits were terminated, you may file a Petition to Reinstate your benefits within three years after the date of your most recent workers' compensation check. If your benefits were suspended, you may file a Petition to have them resumed within 500 weeks from the date of suspension. Payment of medical benefits does not mean that your claim has been accepted or re-opened.

All persons injured at work should immediately seek a consult with an experienced attorney. Far too frequently, we see people who were too trusting in their dealings with insurance company representatives or company representatives. The initial choice of a physician can dramatically affect a worker's entire claim. For example, allowing an insurer or employer refer you to a physician may very well be determined later to have been your choice, and not all health care providers approach patient care in the same way. For over forty years, our firm has represented thousands of workers injured in the workplace. We would be happy to offer a free consultation with absolutely no obligation.

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