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PA Workers Compensation: Work injuries and illnesses
occurring on or after June 24,1996.
WHAT IS WORKERS’ COMPENSATION?
The Pennsylvania Workers’ Compensation Act provides injured workers
with resources to compensate them for medical expenses and lost wages
sustained as a result of injury, death or occupational disease
related to their employment. Benefits are paid either by private
insurance companies or the employer, if the latter is self-insured.
WHO IS COVERED?
Every Pennsylvania
worker should be covered through their employer, including seasonal
and part-time workers. Some Pennsylvania
employees are covered by other compensation laws including: Federal
civilian employees, railroad workers, longshoremen, shipyard and
harbor workers. Other employees, for example volunteers and domestic
workers, may not be covered. If in doubt, you should seek legal
advice.
WHAT IS COVERED?
If you are injured on the job or a working condition cause you to
suffer an illness or disease, you may be entitled to benefits. In
some cases, an injured worker may be entitled to specific loss
benefits. Specific losses consist of the permanent loss or loss of
use of certain limbs or bodily function, including vision, and
hearing loss. Disfigurement of the head, neck, or face are also
considered specific losses.
An injured worker may also be entitled to hearing loss benefits. The
PA Act uses the American Medical Association Guide to Permanent
Impairment to establish the worker’s entitlement to benefits. The
maximum benefit for complete loss of hearing in both ears is 270
weeks, including healing period. The maximum benefit for complete
loss in one ear is 70 weeks, including healing period.
No compensation shall be paid if the injury or death is intentionally
self inflicted, or is caused by an employee’s violation of the law
including, but not limited to, illegal use of drugs or alcohol. Be
aware that each situation needs to be evaluated individually in order
to determine eligibility.
WHEN AM I COVERED?
The first day of hire for medical benefits. Compensation for lost
wages is payable beginning with the eighth day of disability.
However, if you are disabled for 14 days or more, you are entitled to
compensation benefits including the first seven days of your
disability.
WHEN DO I NOTIFY MY EMPLOYER?
Notify your employer/supervisor immediately when an injury occurs, or
when you first realize that an injury or disease is related to work.
Typically a medical provider will notify a person if they believe the
injury or disease is work-related. Non-reporting of the injury is the
reason for a majority of claims being denied or delayed.
Additionally, you should report ALL injuries that you believe
occurred as a result of work - even if the injury does not cause lost
time or disability. Sometimes these small injuries will cause
disability or need for medical treatment in the future. Providing
notice is very important when an employer decides to accept or deny a
claim.
DO I HAVE CHOICE OF DOCTOR?
Your employer must post a list of six or more physicians in your
workplace. You are required to visit one of them for initial
treatment and continue with a provider on the list for 90 days
following the first visit. Employers are responsible for advising
workers of their rights and duties under Section 306(f.1)(1)(i) of
the Act (Medical benefits). A written notice of your rights should be
provided at the time of your injury. If you visit other providers
during this 90 day period, your employer may refuse to pay for such
treatment.
Additionally, your employer has the right to send you for a medical
examination once you start receiving Workers’ Comp benefits. Failure
to attend may result in suspension of your benefits. Your employer
will have you examined in order to determine the extent and nature of
an injury including limitations for possible light duty positions.
There are many issues regarding the choice of a doctor. Ask a legal
professional for advice.
HOW MUCH ARE THE PAYMENTS FOR LOST WAGES?
Wage-loss benefits are equal to approximately two-thirds of your
gross average weekly wage, up to a weekly maximum set by the
Pennsylvania State Supreme Court. Be aware that you may have your
workers’ compensation benefits reduced if you receive other benefits
at the same time. For example: If you receive Social Security or an
employer-paid portion of a retirement pension, severance pay, unemployment
compensation or earnings from other employers. Therefore, you must
provide all income information to the workers’ comp adjuster,
otherwise you might be required to reimburse the insurance company.
WHEN SHOULD I FILE A WORKERS COMPENSATION CLAIM?
When you believe you have an injury as described above and your
employer has denied medical benefits, lost wages or both. You have
three years from the date of the injury to file a Claim Petition. If
the claim is an occupational disease then disability must occur
within 300 weeks from the date of last employment from your exposure.
DO I NEED AN ATTORNEY?
You may represent yourself, but a non-attorney cannot represent you.
Be aware that workers’ compensation litigation is very complex, and
an experienced attorney will represent your employer’s insurance
carrier. Therefore, it would be beneficial to discuss any issues you
may have with an attorney who practices Workers’ Compensation Law.
It's important to understand there are many other issues regarding PA
Workers’ Compensation that were not described here.
If you have further questions about Workers
Compensation Law, contact Paul
B. Himmel, Esquire, at phimmel@FreedmanLorry.com
or call (888) 999-1962.
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