PENNSYLVANIA
WORKERS’
COMPENSATION
HANDBOOK
wwdlaw.com 1-866-413-COMP (2667)
PENNSYLVANIA
WORKERS’
COMPENSATION
HANDBOOK
Labor Law
Employee Benefits
Employment Law
Workers’ Compensation
Pennsylvania Workers’ Compensation Handbook | 3
TABLE OF CONTENTS
About Willig, Williams & Davidson ................................................................ 4
Section 1: Understanding workers’ compensation ........................................... 6
Section 2: What you should do if you have been injured at work...................... 8
Section 3: Understanding your employer’s responsibilities ................................ 14
Section 4: Seeking medical treatment for work related injuries and
payment of medical bills .................................................................16
Section 5: Utilization review requests, medical exams, medical reports
and changes in medical status .......................................................20
Section 6: What to do when your claim is accepted, denied or terminated .......24
Section 7: Wage loss and specific injury benefits ............................................32
Section 8: Other benefits.................................................................................38
Section 9: Suing for negligence and recovering penalties for delays ................42
Pennsylvania Workers’ Compensation Work Injury Checklist
and Notebook .................................................................................................44
Willig, Williams & Davidson 1-866-413-COMP (2667)
ABOUT WILLIG, WILLIAMS & DAVIDSON
No one plans on a work-related injury. Most workers never give workers’
compensation a thought until after they have been hurt or become sick.
Then, on top of dealing with their injury and medical treatment, they are
forced into a complicated legal system without the proper tools to guide
them through.
Willig, Williams & Davidson is committed to helping
workers navigate the system, so they can focus
on one thing – getting well. Our team of certified
workers’ compensation attorneys use their skills
to assist sick and injured workers through the legal
system, so the workers can maintain their dignity
and get the treatment and benefits they deserve.
Our attorneys provide advice, counseling and legal representation to
sick and injured workers, to make sure that they receive 100 percent of
the benefits required by law. And our work injury lawyers who practice in
this area, limit their representation to the protection of injured workers.
Our workers’ compensation attorneys utilize the firm’s wide-ranging
union-side practice to help further the cause of providing safe working
conditions and fair benefits for injured workers. Unlike some other firms,
our attorneys are uniquely suited to understand the complex interplay
between workers’ compensation law and other employment rights, such
as union benefits, the Family and Medical Leave Act (FMLA), Act 534,
and the Heart & Lung Act. Our attorneys use that knowledge to look
beyond the workers’ compensation law and make sure that our clients’
rights are fully protected.
Our attorneys also work closely with union clients to identify injury
trends and eliminate unsafe practices and conditions at work before
workers get hurt. We push the limits of the workers’ compensation law
to force employers to stop illegal practices like refusing to pay loss of
overtime to injured workers or illegally reducing benefits for injured retirees.
Our attorneys use their expertise and broad client base to leverage the
best possible results for our clients, based on our firm belief that sick
and injured workers deserve the best possible legal representation.
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Pennsylvania Workers’ Compensation Handbook | 5
ABOUT THE PENNSYLVANIA
WORKERS’ COMPENSATION
HANDBOOK
This handbook has been prepared by
Willig, Williams & Davidson to provide
assistance to individuals who may be
entitled to benefits under the
Pennsylvania Workers’ Compensation
Act. It is not intended as a substitute for
legal counsel, nor is it designed to answer
all questions which might arise.
This handbook has been set up in a
“question and answer” format to explain
basic principles in easy to understand
language.
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
PENNSYLVANIA
WORKERS’
COMPENSATION
HANDBOOK
wwdlaw.com 1-866-413-COMP (2667)
PENNSYLVANIA
WORKERS’
COMPENSATION
HANDBOOK
Labor Law
Employee Benefits
Employment Law
Workers’ Compensation
Willig, Williams & Davidson 1-866-413-COMP (2667)
What is workers’ compensation?
The Pennsylvania Workers’ Compensation Act provides wage loss
and medical benefits to compensate employees suffering from work-
related injuries or diseases. The Act also provides for death benefits to
the dependents of workers who die as a result of a work-related injury or
disease. Workers’ compensation benefits generally are paid by private
insurance companies which have insurance policies with your employer.
While the Bureau of Workers’ Compensation administers the system, it
does not make the initial determination as to whether you are entitled
to receive workers’ compensation benefits. If you disagree with the
insurance company’s determination, you may file a petition to have
a workers’ compensation judge decide your case.
What is a compensable workers’ compensation injury in PA?
Under Pennsylvania law, the following conditions are considered
compensable injuries under workers’ compensation:
1. Specific incidents that cause an injury.
2. Repetitive activity resulting in an injury. This includes conditions like
carpal tunnel syndrome caused by repetitive movement.
3. A pre-existing condition that has been aggravated by work activities.
This includes conditions like arthritis, heart disease. The pre-existing
condition does not have to be work-related for the aggravation to be
covered under workers’ compensation.
What diseases are covered by the Pennsylvania Workers’
Compensation Act?
The Act provides a list of specific diseases which are recognized as
occupational diseases. These include (but are not limited to):
tuberculosis and hepatitis for nurses, blood processors, and related
professions which involve exposure to these diseases; diseases of the
heart and lungs for firemen who have four or more years of service;
pneumoconiosis and silicosis for any occupation that involves direct
contact with or exposure to coal dust; specific types of chemical
poisoning (such as lead, mercury, phosphorus and arsenic) for
occupations involving direct contact or exposure to these chemicals,
or to their preparations or compounds.
Section 1: Understanding workers’ compensation
Pennsylvania Workers’ Compensation Handbook | 7
The Act provides for compensation for other occupational diseases not
specifically recognized, as long as three criteria are met:
a. the employee is exposed to the disease by reason of employment;
b. the disease is causally related to the employee’s main industry or
occupation; and
c. the occurrence of the disease is substantially greater in the industry or
occupation than it is in the general population.
Even if you suffer from a disease which is neither specifically recognized
nor meets the criteria listed above, you may be entitled to workers’
compensation benefits.
If you develop the disease as a result of an exposure which occurs at
work, workers’ compensation benefits are the same as those paid for
injuries. Pre-existing occupational diseases aggravated by employment
are treated in the same manner as injuries. The criteria listed in the
previous paragraph do not have to be satisfied for this type of claim
to be compensable.
Firefighters, police officers and certain public safety employees may be
able to claim benefits for specifically listed diseases/illnesses related to
their employment.
Must the injury occur on the employer’s premises to be
compensable under PA law?
An injury does not need to occur on the employer’s premises to be
compensable under the Act. As long as your injury occurred while you
were in the course and scope of employment, the injury is compensable.
For example, if you are injured in an automobile accident while running
an errand for your employer, the injury is normally compensable. On the
other hand, injuries that occur while you are on your way to or from
work are not compensable. If you are injured on your employer’s
premises on your way in or out of work, your injury may be
compensable. In addition, commuting may be covered if you are
a traveling employee.
Section 1
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What should I do if I suffer a work injury?
When you suffer an injury as a result of an accident or repetitive injury,
you should give notice to your supervisor or any other person designated
by your employer immediately. You should report the injury even if you
do not anticipate missing time from work. Notice can be given either
verbally or in writing. If required, complete an incident report. If you
require medical treatment, you should request the list of designated
health care providers approved to treat work injuries. You are required
to treat with these physicians for 90 days after the date of your first visit
to the doctor. If your employer does not have a list of approved doctors,
seek medical treatment from any physician. Be sure to inform your
physician that your injury is work related.
Within 21 days of your injury, your employer or its insurance company
must notify you whether they agree that you sustained a work injury. The
company is required to issue a form entitled Notice of Compensation
Payable, which agrees that you have a work-related injury, or a Notice
of Compensation Denial, which denies that you have a work injury. If
your claim is accepted, review the Notice of Compensation Payable to
determine whether your injury is described accurately and whether your
wages are accurate. If your claim is denied, seek medical care with your
own physician and obtain legal advice.
What is a Notice of Compensation Payable?
A Notice of Compensation Payable is a legal document issued by the
workers’ compensation insurance company or employer. If you miss time
from work, the Act requires that the insurance company or employer
decide whether they are agreeing to cover an injury under the law within
21 days of the date of disability. The Notice of Compensation Payable is
legal confirmation that an injury has been accepted under the law. The
Notice contains important information about both the wage loss and
medical benefits to be paid. Specifically, the Notice of Compensation
Payable will state the amount of the injured worker’s average weekly
wage, upon which the wage loss benefit is calculated. In addition, the
amount of wage loss benefits is listed, along with the start date of the
benefit. The Notice will list the legal description of the work injury.
Section 2: What you should do if you have been injured
at work
Pennsylvania Workers’ Compensation Handbook | 9
It is important to make sure that the description of the injury is correct
because the insurance company will only be required to pay for
reasonable and necessary medical treatment related to that specific
work injury. For example, if the Notice lists a shoulder sprain, the
insurance company may not be required to pay for surgery to repair
a rotator cuff tear.
How should a work-related injury or disease be reported for
purposes of workers’ compensation?
It is your responsibility to report an injury or disease to your employer as
soon as possible. The report should include an explanation of the time,
place and type of injury. The notice must contain an explanation as to
how the injury occurred and how it was work-related. Although verbal
notice is legally sufficient, it is best if the notice is in writing. You should
retain a photocopy of the notice. You should give as much information
as possible to your employer regarding the circumstances surrounding
the injury. The report may be given to the employer by you or by
someone acting on your behalf.
There are two time limits which are strictly enforced:
1. Notice given more than 120 days from the date of injury will likely
preclude workers’ compensation benefits; and
2. You must give notice within 21 days from the date of injury in
Pennsylvania in order to receive workers’ compensation benefits
from the first day of injury.
If you do not give notice until the 22nd day after the injury occurred, you
will only receive workers’ compensation benefits from that date on. If
notice is given within 21 days, however, you will receive benefits from
the first day of injury.
Section 2
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How should an occupational disease be reported?
The time period for giving notice of an occupational disease begins to
run when you know or should know that your occupational disease is
related to employment. The important thing to remember is that if you
learn that you have contracted an occupational disease, you should
provide immediate notice to your employer, or a previous employer,
even if you have not worked for the employer recently. It is sufficient
for someone acting on your behalf, including your doctor, to provide
such notice. The notice must contain a statement that the disease
is work-related; otherwise, you might be denied workers’
compensation benefits.
What are considered occupational workplace diseases?
Occupational diseases include chronic disease caused by or due to
activities or environmental factors at the work place. There are many
different types of occupational diseases. They can include: cardiovascular
system disease; central nervous system disease; heart and lung
disease; liver disease; musculoskeletal disease; occupational cancers
such as mesothelioma; psychiatric diseases/mental health disturbance;
renal disease; reproductive system disease; and skin disease.
These occupational diseases are often caused by exposure to
“causation agents,” which can include: asbestos, gas, infectious agents,
metals, noise, pesticides, herbicides, rodenticides, fungicides, pressure,
radiation, solvents, temperature and vibrations.
What should I do if my employer insists that I use my sick time
instead of workers’ compensation?
Because it ordinarily takes several weeks for a worker’s compensation
claim to be processed, there is no reason for you not to use accumulated
sick leave. If you use sick time, make sure that you report that you are
using sick time for a work-related injury. The Workers’ Compensation
Act ordinarily does not give insurance companies the right to take a
credit for sick pay you receive. If you are a member of a union, check
your union contract carefully to determine what benefits are available.
If your employer forces you to use sick time for a work injury, you are
probably not being covered under PA Workers’ Compensation.
Pennsylvania Workers’ Compensation Handbook | 11
How should I deal with a workers’ compensation insurance adjuster?
When you are injured at work, your claim is processed by your employer’s
workers’ compensation insurance company. An adjuster is assigned to
handle the claim and is responsible for determining whether the claim
will be covered under workers’ compensation. The adjuster is required
to complete the investigation of your claim within 21 days. You can
assist the adjuster by helping to gather relevant medical records.
Once your claim is accepted, you may need to communicate with the
adjuster regarding the payment of your wage loss benefits or obtaining
medical treatment. Keep in mind, the adjuster works for the insurance
company and may not be as responsive to you as you would like. Be
persistent, follow up, and ask for a supervisor if you cannot get a
response from the assigned adjuster. The adjuster is not required to
advise you of your rights under the law and often provides
misinformation. Being informed about your rights is the best
protection you have from mistreatment by an adjuster.
Should I sign a medical records release for the workers’
compensation insurance company?
Your employer’s workers’ compensation insurance company is required
to investigate your claim and determine whether it will be covered under
workers’ compensation. They will want to see what the doctors are
saying about your condition. Signing the release may make it easier
for the company to investigate and approve your claim. The law does
not require you to sign a medical records release for your claim to be
covered under workers’ compensation.
How do I know if my workers’ compensations claim has been
accepted?
Your claim has not been legally accepted under the Pennsylvania
Workers’ Compensation Act unless you receive a document entitled
Notice of Compensation Payable. This is a legally binding document
which is issued by the workers’ compensation insurance company
which is handling your case for your employer. Your employer is not
legally bound to cover your case unless this document is issued. Even
if your employer is paying all of your medical bills, they are not legally
responsible for your claim unless this document has been issued.
Section 2
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Your employer and its insurance carrier can agree to provisionally
accept your claim by issuing a Temporary Notice of Compensation
Payable. This document temporarily makes your employer responsible
for your injury. The employer/insurance carrier can end their responsibility
at any time within 90 days of your injury by issuing a Notice Stopping
Temporary Notice of Compensation Payable and a Notice of
Compensation Denial. If your employer and its insurance company
does not stop the TNCP within 90 days, it will convert to a Notice of
Compensation Payable which makes your employer legally
responsible for your claim.
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
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Pennsylvania Workers’ Compensation Handbook | 13
Q. Do I have to use sick time if I
miss time due to a work injury?
A. Anytime you miss work because of a work injury, make
sure that you alert your employer to the absence being
related to your injury. If you miss less than one week of
work due to a work injury, your missed time may need to
be taken as sick leave because Pennsylvania Workers’
Compensation law does not cover absences of less than
one week.
If you are out of work for more than one week, you may
be required to use sick time to cover your absence until
the workers’ compensation insurance company agrees
to cover your injury under workers’ compensation. The
insurance company has 21 days to investigate your claim
and let you know whether you are being covered for lost
time. If you do not receive paperwork from the insurance
company indicating that your injury is being covered, you
are not being covered and should seek legal advice.
If the insurance company has agreed to cover your claim,
you should not be required to use sick time while you
are out of work, unless you are out of work for less than
one week.
If your employer forces you to use sick time for a work
injury, your claim may not be covered under PA Workers’
Compensation.
Section 2
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When must my employer prepare an injury report?
Under Pennsylvania law, employers are obligated to keep records of all
injuries which occur on the job. Whenever such an injury results in the
loss of a day, shift, or turn, the employer must complete Form LIBC-
344, Employer’s Report of Occupational Injury or Disease. The employer
must file such a report only if it is aware of your work-related injury or
disease. The employer must complete this form even if it disputes your
contention that an injury or disease is related to employment, or that
it occurred at all. You are entitled to receive a copy of the Employer’s
Report of Occupational Injury or Disease.
What do my employer and its workers’ compensation insurance
company have to do once I report a work injury?
The employer should report your injury to its workers’ compensation
insurance carrier. Under the law, the employer or its carrier has an
obligation to investigate your injury report and pay compensation if due.
If you miss time from work, the employer or its carrier has an obligation
to issue a Notice of Compensation Payable, agreeing you had a work
injury, or a Notice of Compensation Denial, denying that you had a work
injury, within 21 days of the first day you missed from work.
May an employer terminate my employment after I have suffered a
work injury?
Your employer may have the legal right to terminate your employment
after you suffer a work injury. The fact that you were injured on-the-job
does not protect your job. If you are covered by a collective bargaining
agreement, you may have additional job protection. The Family and
Medical Leave Act requires that most employers grant 12 weeks of
unpaid leave time per year to employees who cannot work due to a
serious medical condition. If you qualify for FMLA, you should request
that your absence be covered under FLMA to protect your job for 12
weeks. If you are a member of a union, many collective bargaining
agreements include provisions which protect an injured worker’s job.
Consult your collective bargaining agreement and discuss job protection
with your union representative immediately after your injury.
Section 3: Understanding your employer’s responsibilities
Pennsylvania Workers’ Compensation Handbook | 15
Must an employer rehire me if I have recovered in part or in full from
my work-related injury?
Unfortunately, the Workers’ Compensation Act does not require an
employer to rehire you if you have recovered from a work injury.
However, if you were injured after June 23, 1996, have not recovered,
and are not working, your employer must offer any available light duty
work to you before it can claim that your benefits should be reduced
to reflect wages that you could earn if you found a job with
another employer.
Section 3
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
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May I choose to treat with my own physician?
Unless your employer has posted a list of medical providers with whom
you must treat in connection with a work injury, you have the right to
choose your own physician. If, however, your employer has posted a list
of at least 6 designated health care providers, no fewer than 3 of whom
are physicians, the Act requires you to treat with one or more of these
medical providers for a period of 90 days from the date of the first visit
to the provider. After 90 days, you should seek medical treatment with
your own doctor.
If the list is not posted, and you are not told of your rights, you are under
no obligation to treat with any medical provider recommended by your
employer. If the employer has posted a list of medical providers, you
have a right to choose any of the providers on the list. The Act does
not give your employer the right to force you to treat with a specific
provider on the list. If you do not comply with this particular provision,
the employer and its workers’ compensation insurance company are not
required to pay for health care services provided during this period. Your
refusal to treat with an employer’s panel physician does not relieve the
employer of its obligation to pay wage loss benefits to you during your
period of disability. You may, however, have to pay for your work-related
medical treatment, because your health insurance company may not be
responsible for medical bills incurred during this period of time.
In the event that a dispute arises concerning the insurance company’s
obligation to pay for medical bills incurred during this period of time,
your employer or its workers’ compensation insurance carrier must
produce a document signed by you in which you acknowledge that you
understood your rights and duties under this section of the Act.
Must I treat with an employer-designated physician if my workers’
compensation claim has been denied?
The Act is silent about whether you have an obligation to treat with an
employer-designated physician in the event your claim is denied. If you
treat with an employer-designated physician after your claim has been
denied, however, you could end up being responsible for large medical
bills, particularly if you have health insurance through a health
Section 4: Seeking medical treatment for work related
injuries and payment of medical bills
Pennsylvania Workers’ Compensation Handbook | 17
maintenance organization (HMO). Insurance Department regulations
impose upon your health insurer the obligation to pay medical bills for
your work injury in the event of a denial. Accordingly, if your employer
denies your claim, you are free to seek medical treatment by the physician
of your choice. You should provide your physician with a copy of the
insurance company denial letter. Your physician will then photocopy the
denial letter and submit your medical bills and a copy of the denial to
your health insurance company.
It is particularly important that you cease treating with an employer-
designated physician if your claim has been denied and you have
coverage through a health maintenance organization. HMOs ordinarily
require that you treat with a primary physician. Referrals to specialists
must be made by the primary physician, and the referrals ordinarily must
be made to a participating specialist.
If your claim is denied and you continue to treat with an employer-
designated physician, and you lose your workers’ compensation case,
you may be held personally responsible for medical bills incurred in the
event the workers’ compensation insurance company refuses to pay the
bills of the employer-designated physician. If you have ordinary health
insurance, your bills should be covered. You should not assume that the
workers’ compensation insurance company will pay your medical bills
merely because you are treating with a “posted” physician. Insurance
companies can and do refuse payment to such physicians, and if you
have not been referred to the posted physician in accordance with the
terms and conditions of your HMO coverage, the HMO will almost
certainly decline to make payment, as well.
Can I get a second opinion and have it covered under workers’
compensation?
Under the law, you are entitled to obtain a second opinion, at no charge
to you, if the panel doctor has recommended surgery. You are not
entitled to a second opinion for treatment recommendations such as
therapy; work restrictions; or failure of the provider to order diagnostic
testing. If you believe that you are not being treated properly by a panel
Section 4
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physician, you can ask to change to another provider on the panel. After
the first 90 days following an injury, you should seek treatment or
a second opinion with any provider of your own choosing.
Can I change physical therapist when I’m being treated under
workers’ compensation?
For the first 90 days following your injury, you are required to treat with a
panel provider. This includes physical therapy providers, if one is listed
on the panel. However, if no physical therapy provider is listed on the
panel, you are free to seek treatment at whichever therapy provider you
choose, even within the first 90 days.
Should I tell a workers’ compensation doctor about prior injuries?
An injured worker should always give a complete medical history to any
physician who is evaluating the work injury. Prior injuries or pre-existing
conditions are not a bar to receiving workers’ compensation. Therefore,
it is best to give a treating physician complete information about prior
injuries or conditions. Some employers and insurance companies will
use prior injuries or pre-existing conditions are a reason to deny a claim.
Nevertheless, that denial can be appealed and reversed by a PA
workers’ compensation judge. The Act specifically states that an
aggravation of a pre-existing condition can constitute a new injury
and be covered under Pennsylvania workers’ compensation.
What should I do if I get a notice for an independent doctor to
review my workers’ compensation claim?
Your employer and its insurance company is allowed to send you for an
Independent Medical Exam (IME) every six months to get an evaluation
of your condition by a doctor of their choosing. You do not have the
right to ask for a different doctor, specialist or location. However, the
employer must provide transportation to the examination for the injured
worker. You must attend and participate in the exam and be cooperative.
Even if requested, you are not required to provide any medical records
or documentation to the IME physician. It is important to be truthful and
forthright about your medical history, your work-related condition and
your ongoing treatment. You should see your own treating physician
soon after seeing the IME physician so your own doctor can evaluate
your condition. Approximately 4-6 weeks after the exam, you will receive
a copy of the doctor’s report.
Pennsylvania Workers’ Compensation Handbook | 19
What medical information should I submit to my employer or its
insurance carrier so that my medical bills are paid?
Employers or their workers’ compensation insurance carriers need only
pay medical bills which are related to a work injury. Accordingly, they
are entitled to require reports and other records to properly determine
whether a bill is for treatment of a work-related injury or disease.
Injured workers should make sure that their physicians are submitting
regular medical reports to the insurance carrier or the employer so that
these medical bills are paid.
If the employer has provided a list of medical providers, you may see a
new doctor after you have treated with a company doctor for 90 days. If
you change doctors, you must notify your employer within 5 days. The
new physician must file a report within 21 days of your first visit and file
a report once a month thereafter for the duration of treatment.
How can I avoid delay or denial of payment of my medical bills?
One of the most common problems faced by injured workers is their
inability to obtain payments of medical bills. In order to ensure that
medical bills are paid, you should make sure your provider submits bills
in an organized and timely fashion. The bills should contain complete
and adequate information, including correct names, dates of treatments,
services provided and cost of treatment. You should make sure that
your treating physicians are submitting the required monthly reports.
Submitting bills with medical reports is required. Copies of all
documents that you submit to the insurance carrier should be kept
for your own records.
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What is a Utilization Review Request?
A Utilization Review Request is designed to determine the
reasonableness and/or necessity of your medical treatment in a workers’
compensation matter. Ordinarily, such petitions are filed by the
insurance carrier, although injured workers are free to file such a petition.
Once such a request is filed, it is assigned to a Utilization Review
Organization (U.R.O.). The U.R.O. ordinarily contacts your medical
providers with a request that the medical providers send copies of your
records to the Organization. Under the law, your medical providers are
entitled to bill $.07 per page for copying of these documents. Please
note that it is imperative that all of your medical providers send your
medical records to the U.R.O. If these medical records are not sent, the
U.R.O. will base its decision on whatever documents are sent to it by
the insurance company. In this situation, the U.R.O. will ordinarily rule
against your doctors. The failure of the doctors and other medical
providers to send records is one of the most common reasons why
treatment is found to be unreasonable or unnecessary. It is extremely
helpful, although not strictly necessary, for your physician or medical
provider to write a brief note explaining why your treatment is
reasonable, necessary and causally related to your work injury.
It is also extremely helpful if you submit a short statement explaining
what benefits you receive from the treatment, including pain relief and
increased ability to function. If the U.R.O. finds that your treatment is
either unreasonable or unnecessary, you have the right to appeal.
Must I submit to independent medical examinations?
Employers or their insurance carriers may require you to submit to an
independent medical examination. Employers or insurance carriers may
also request that you undergo medical examinations after you are
receiving compensation no more than once every six months.
Employers are responsible for examination costs, reasonable travel
expenses and your wage loss resulting from the examination.
Section 5: Utilization review requests, medical exams,
medical reports and changes in medical status
Pennsylvania Workers’ Compensation Handbook | 21
Must I report employment and self-employment information to the
workers’ compensation insurance company?
You have an obligation to report employment and self-employment
earnings to the workers’ compensation insurer when you are
seeking or receiving compensation. You have a duty to cooperate with
the insurer in an investigation of employment, self-employment,
wages and physical condition. If you are receiving wage loss benefits,
the insurer may require you to complete a verification form pursuant to
the statute. You must complete the verification form and return it to the
insurer within 30 days of receipt. If it is not returned within 30 days, the
insurer can suspend compensation until the verification form is returned.
The employer does not have to pay you for wage loss benefits
suspended due to your failure to return the form.
What happens if my disability status changes after a workers’
compensation claim has been accepted?
If you recover to the point that you remain partially disabled but you can
return to work, you and your employer may execute a Supplemental
Agreement to reflect the change in your disability status. If you continue
to sustain wage losses after you return to employment, the Supplemental
Agreement should require the employer or its workers’ compensation
insurance carrier to continue paying two-thirds of the difference
between your post-injury and pre-injury wages. If, after returning to work
(either regular duty or light duty), you become disabled once again due
to your work-related condition, you should obtain a new Supplemental
Agreement reflecting that you are entitled to total disability benefits.
Can a workers’ compensation insurance company stop paying
benefits to me when I return to work?
An insurance carrier is entitled to suspend payment of wage loss
benefits to an injured worker if the employee has returned to work at
wages equal to or greater than his pre-injury wages. In order to do so,
the insurer must send a Notification of Suspension or Modification to the
employee. The employee then has the right to challenge the employer’s
Notification by completing the form and filing with the Bureau of
Workers’ Compensation within 20 days. If no challenge is received, the
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Notification will become legally binding. Whenever you receive a
Notification of Suspension or Modification, you should file a challenge.
Filing a challenge will make sure your rights are protected, even if you
have returned to work. Once a challenge is filed, the Employer has to
prove that they are legally permitted to stop or reduce your benefits.
What is the employer’s obligation if I have only a partial recovery
from my work injury or disease?
If you return to work, either to a modified position or full duty, and are
earning less than you did before your work injury, your employer may be
obligated to pay you partial disability benefits. If you are earning less as
a result of your work injury, you are entitled to partial benefits representing
2/3 of the difference between your pre-injury average weekly wage and
your present earnings. If you are released to light duty or modified work
and your employer does not offer you a position within your restrictions,
you will continue to receive total disability benefits.
Your employer may be able to reduce your benefits by showing that
you have an earning capacity and that there are jobs in the economy
available to you.
What is a vocational interview and must I submit to one?
If you have been cleared to return to some type of work, the insurance
company will try to reduce or stop your benefits by showing that there
are jobs for you. The insurance company begins this process by hiring
a vocational counselor to interview you about your background and
abilities.
What is a Notice of Ability to Return to Work?
If the insurance company receives medical evidence indicating that you
are able to return to work in some capacity, you may be sent a Notice of
Ability to Return to Work. It indicates that you have an obligation to look
for available employment and that proof of available employment may
jeopardize your right to receive ongoing benefits.
The Notice does not mean you are suppose to go back to your previous
job. It just means that the insurer believes you have the ability to work in
some way.
Pennsylvania Workers’ Compensation Handbook | 23
What is a Labor Market Survey?
In Pennsylvania, a labor market survey, conducted by a certified
vocational counselor, determines work that you are capable of
performing, considering job listings in you area. Your employer may
be able to reduce your compensation benefits by showing that you are
able to perform previous work or, considering your education, age,
and work experience, you can engage in other substantial gainful
employment which exists in your geographic area. If the employer
responsible for payment of compensation has an available job which is
within your physical and vocational abilities, it must be offered to you.
Section 5
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
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What happens if my workers’ compensation claim is accepted?
If your claim is accepted, the employer or its insurer must complete
and submit to the Bureau of Workers’ Compensation a Notice of
Compensation Payable and Statement of Wages. The Notice of
Compensation Payable is an acknowledgment by your employer that
your injury is work-related. The document obligates the company to
pay wage loss and medical benefits to you. The Notice of Compensation
Payable contains a description of the injury and the applicable
compensation rate. The compensation rate is calculated in accordance
with a formula set forth in the Statement of Wages.
Your employer can provisionally agree that you have a work injury and
are entitled to workers’ compensation by issuing a Notice of Temporary
Compensation Payable. Your employer can rescind this document for
any reason within 90 days. If your employer does not rescind the Notice of
Temporary Compensation Payable, it will convert into a Notice of
Compensation Payable. You may want to file a claim petition to protect
your rights even though your employer has filed a Notice of Temporary
Compensation Payable.
What should I do if my workers’ compensation claim is denied?
The Pennsylvania Workers’ Compensation Act requires an employer
to either accept or deny a claim within 21 days of the date that notice
of the work injury is provided by the injured employee to the employer.
Insurance companies deny claims by issuing a Notice of Workers’
Compensation Denial. Often a denial will be issued because the
insurance adjuster has not had sufficient time to investigate the claim.
If you receive a Notice of Workers’ Compensation Denial, you should
check to make sure that the insurance company has received written
confirmation from your treating physician that your condition is work-
related and that you are, at a minimum, partially disabled as a result of
your work injury or are incurring medical bills in connection with the
injury. If the adjuster has all necessary information but persists in the
denial, you should contact Willig, Williams & Davidson and its work
injury lawyers immediately. You should do so even if the adjuster
says that this is only a “conditional denial” and the company will
Section 6: What to do when your claim is accepted,
denied or terminated
Pennsylvania Workers’ Compensation Handbook | 25
re-evaluate its position once you have undergone an “independent”
medical evaluation.
How long do I have to file a claim petition for workers’
compensation in PA?
If your claim is denied, you are entitled to file a Claim Petition. A claim
petition must be filed within in 3 years of the date of injury. In the case of
an occupational disease, 3 years from the date of wage loss or from the
date when the worker knew that the injury was work-related, whichever
is later, provided it is within 300 weeks.
Should I hire a workers’ compensation attorney?
Under most circumstances, you should hire an attorney to handle
petitions before a workers’ compensation judge. The insurance company
will always utilize an experienced attorney who will do a professional
job of protecting the insurance company’s rights. While most judges will
grant considerable leeway to you if you are not represented by an
attorney, you must be familiar with workers’ compensation law and
procedure and must be prepared to present all evidence necessary to
meet your burden of proof.
How can I pay for an attorney?
Most attorneys, including those at Willig, Williams & Davidson, will
charge you a fee only if they are successful in obtaining or protecting
your benefits. The Workers’ Compensation Act limits attorney’s fees
to no more than 20% of your compensation except under special
circumstances.
How are claim petitions processed by the Bureau of Workers’
Compensation?
After a petition is filed, it is assigned to a location based upon the
county where you live. At the same time that the petition is assigned
to a judge, a copy is served upon the employer and its workers’
compensation insurance carrier. Your employer or its carrier has 20
days from the date of service to file an answer to your petition.
After your employer or its insurance carrier files a response to the
petition, the judge will schedule a hearing. In attendance at the hearing
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will be you, your attorney, an attorney representing your employer, a
court reporter, and the judge. At the conclusion of the first hearing the
judge will issue a trial schedule and the record is left open for medical or
expert testimony.
If the claim is for 52 weeks or less of disability, doctors’ reports may be
submitted to support of the claim. For claims longer than 52 weeks, it is
necessary to present testimony from your physician. This testimony will
be taken by deposition at your doctor’s office. Present at the deposition
will be your attorney, a court reporter, an attorney for your employer,
and the physician. The physician answers questions on direct testimony
concerning your diagnosis, prognosis, level of disability, and cause of
your condition. The doctor must then answer questions on cross-
examination from opposing counsel. The court reporter transcribes the
testimony in a transcript which is submitted to the judge at a later hearing.
Are the issues in a workers’ compensation case decided in a single
hearing?
The issues in a workers’ compensation case are not decided in a single
hearing. After a petition is filed with the Bureau, the case will be
assigned to a workers’ compensation judge. In most circumstances,
the case will be assigned to the judge who is closest to your home.
Pennsylvania workers’ compensation cases may take several months
to more than a year for a final decision to be made.
Are other benefits available pending the outcome of a workers’
compensation claim petition?
Some employers provide sickness and accident benefits insurance for
employees. Even where such benefits are not provided, you may seek
social security disability, unemployment compensation, welfare,
veterans’ benefits, or pension benefits. Some of the benefits may reduce
your workers’ compensation payments.
What is a Supplemental Agreement?
A Supplemental Agreement acts as an acknowledgment by the
employer that an employee’s status has changed.
Pennsylvania Workers’ Compensation Handbook | 27
Is it legal for an employer to require me to sign a Supplemental
Agreement before I go back to work?
You are not required to sign a Supplemental Agreement to return to work
following a work injury. An employer may not require you to admit that
you have recovered as a condition for returning to work.
Under what circumstances can my employer attempt to suspend or
terminate my workers’ compensation benefits?
If you return to work at the same earnings you had before your injury,
your employer will suspend your wage loss benefits. This does not
require a judge’s approval but can be accomplished with the filing of
a Notification of Modification or Suspension (LIBC-751) If you did not
return to work, returned to work at a loss of wages, or returned to work
but could not continue to work because of your injury, you can
challenge the suspension of your benefits by completing the “Employee
Challenge” section on the back side of the Notification and mailing to
the Bureau of Workers’ Compensation in Harrisburg. This must be filed
within 20 days. A suspension of wage loss benefits does not end your
right to continue to receive medical treatment for your work injury.
An employer can file a petition to suspend wage loss benefits if it has
evidence that the injured worker can work either at their pre-injury job
or alternative work. The employer typically relies upon an independent
medical exam and a vocational expert as the basis of this type of
petition. If the petition is granted by a judge, wage loss benefits will stop.
An employer can also file a petition to terminate if it has evidence that
the injured worker has fully recovered from the work injury. A termination
of benefits means that the claim will be closed for both wage loss and
medical benefits. The employer typically relies upon an independent
medical exam as the basis of this petition. If granted by a judge, the
claim will be closed and likely cannot be re-opened.
What happens if my employer files a Petition to Terminate my
workers’ compensation benefits?
If your employer files a Petition to Terminate your workers’ compensation
benefits, your case will be assigned to a judge who will decide whether
you have fully recovered from your work injury. First, the judge will make
a preliminary determination as to whether your benefits will continue
while the petition is being litigated.
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This preliminary determination is based on the employer’s Request for
Supersedes. The employer will submit documentation that you have
fully recovered from your injury. In response, you will need to submit an
affidavit documenting that you believe you continue to be disabled, as
well as a report from your doctor confirming that you continue to be
disabled and require medical treatment. The judge will then evaluate the
documents submitted and can provisionally stop your benefits if your
medical evidence is not sufficient to establish that you have not fully
recovered and are not likely to win the case. Judges rarely grant a
request for Supersedes.
Regardless of whether a judge grants Supersedes and provisionally
stops your benefits, the case is not over. Additional hearings will be
scheduled, at which time both you and your employer will have the
opportunity to develop a full record. Depositions of both you and your
employer’s medical experts will be taken, and the transcripts of those
depositions will be submitted into the record.
If, at the conclusion of the case, the judge finds that you continue to
be disabled, the employer’s petition will be denied and dismissed. If a
Supersedes Order was previously granted, the judge will order that
back compensation be paid to you covering the period in which the
Supersedes Order was in effect.
If I am disabled from performing my pre-injury job and I am
receiving total disability benefits, are there any limits on the
time during which I may receive such benefits?
If you suffered a work-related injury or disease, you are entitled to
continue to receive total disability benefits as long as you are disabled.
If you voluntarily remove yourself from the job market, or take pension
or social security retirement benefits, the employer may be entitled to
reduce your benefits.
The Pennsylvania Supreme Court has recently ruled that Impairment
Rating Evaluations (IRE) are unconstitutional. Employers can no longer
stop an injured worker’s wage loss benefits based upon an IRE
determination that the injury was less than a 50% whole
body impairment.
Pennsylvania Workers’ Compensation Handbook | 29
If you underwent an IRE, call our office to discuss how the recent
decision affects your entitlement to wage loss benefits. If you receive a
notice that you have been scheduled to attend an IRE, please call our
office before attending the IRE to understand how attending the IRE
could affect your right to continue to receive wage loss benefits.
What should I do if my employer is taking steps to reduce or
terminate my workers’ compensation benefits?
If you receive an offer of employment by your employer and your
physician does not believe you should accept this offer, you should
contact an attorney immediately.
If you are receiving benefits and the workers’ compensation insurance
company requests that you undergo an “independent medical
examination” or hires a vocational expert to conduct a vocational
interview, you should contact a certified workers’ compensation attorney.
If you receive a Petition to Terminate, Suspend or Modify your
compensation benefits, you will need an attorney.
May the parties to a workers’ compensation case settle a workers’
compensation claim?
Employees and insurers are permitted to reach a compromise and
release of all liability under the Workers’ Compensation Act. For
example, the parties may dispute whether an injury occurred in the
course and scope of the employee’s job. In order to avoid the risk of an
unfavorable ruling by the judge, the parties may agree to limit the claim
for a particular period of time, specifically describing the sum of money
which the insurance company is willing to pay and specifically
describing the medical bills for which the company will be responsible.
The Workers’ Compensation Act describes the information which any
compromise and release must contain, and a workers’ compensation
judge must approve the compromise and release if it is established on
the record that the employee understands and agrees to the terms of
the compromise. Judges are required to schedule a mandatory
mediation unless it is deemed futile.
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What happens if the record in my workers’ compensation case
is closed?
The judge will order that the attorneys prepare briefs after all the
evidence has been submitted. Briefs are formal written summaries of the
evidence presented in the case accompanied by arguments concerning
any legal issues presented by the case. Briefs are normally submitted
with proposed findings of fact and conclusions of law.
The judge will consider the entire record of the case, review the briefs,
proposed findings of fact, and conclusions of law, and issue a formal
written decision. It generally takes a judge three to six months to issue
a decision, however, it can take longer. When the decision is issued, the
losing party has 20 days to file an appeal of the decision to the Workers’
Compensation Appeal Board.
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
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Pennsylvania Workers’ Compensation Handbook | 31
Section 6
How to Get Accurate Information About Your
Rights Under Workers’ Compensation
If you want accurate information on workers’ compensation
in Pennsylvania, call the certified workers’ compensation
attorneys at Willig, Williams & Davidson at 800-631-1233.
Most people never think about workers’ compensation until they are
injured. At that point, the worker is overwhelmed with being injured.
Most information about an injury and claim is being provided by the
employer or employer’s workers’ compensation insurance company.
Unfortunately, employers and insurance companies are not obligated
to tell you, the injured worker, about your rights under the Pennsylvania
Workers’ Compensation Act. In fact, they are not even obligated to tell
you the truth about what injuries are covered under the Act.
It is not unlawful for an employer to tell an injured worker that their injury
is not covered under workers’ compensation, when in fact it is covered.
Employers and insurance companies often will tell injured workers that
their injury isn’t being covered because it is a pre-existing condition.
They will say this even though the injured worker may never have had
treatment for the condition before. However, the Pennsylvania Workers’
Compensation Act specifically allows for aggravations of pre-existing
conditions to be covered under the law.
Misinformation about what is covered by workers’ compensation is all
too common. It is very important for injured workers to have someone
to advise them of their rights when they get injured and are working
through the initial stages of their claims. Relying on information from the
employer or its insurance company almost certainly means that injured
workers are being deprived of accurate information about their rights.
It is very important that injured workers have access to accurate
information about their rights under the Pennsylvania Workers’
Compensation Act immediately after they are injured. The workers’
compensation attorneys at Willig, Williams & Davidson are all certified
by the Pennsylvania Supreme Court. We offer free consultations for
injured workers to ensure that you have accurate information about how
your claim should be handled, including questions about treatment with
workers’ compensation panel doctors and the length of time you must
treat with those doctors.
FROM COLLECTIVELY…THE BLOG BY WILLIG, WILLIAMS & DAVIDSON
Willig, Williams & Davidson 1-866-413-COMP (2667)
What wage loss benefits am I entitled to under PA Workers’
Compensation if I am injured on the job?
If you are out of work for more than 7 days, including weekends, as
a result of a work-related injury or disease, you are entitled to begin
receiving wage loss benefits under the Workers’ Compensation Act in
Pennsylvania. If the disability lasts for 14 days or more, you are entitled
to receive wage loss benefits for the entire period of missed time. To
qualify for benefits, the lost work days need not be consecutive.
During your period of work-related disability, you are entitled to receive
wage loss benefits equal to two-thirds of your pre-injury average wages
up to a statutory maximum. Low wage or part-time workers may receive
more than two-thirds of their pre-injury wages. When calculating wages,
your employer or its insurance carrier must take into account wages
from all sources of employment, and include overtime and bonuses.
You may also be entitled to wage loss benefits even if you never missed
time from work. If your work injury results in you making less money, you
may be entitled to partial disability benefits. This often occurs when an
injured worker is working in a light duty job following a work injury or no
longer receives overtime or shift differentials. If you frequently worked
overtime prior to an injury and can no longer work overtime because of
your injury, or you are no longer receiving a shift differential, you may
be entitled to wage loss benefits equal to 2/3 of the difference between
your pre-injury pay with overtime or shift differential and what you are
making on light duty.
In addition to wage loss benefits, injured workers may be entitled to
specific loss or disfigurement benefits. If your injury results in a
permanent scar on your head, face or neck, you are entitled to receive
benefits - even if you never missed time from work. If your injury resulted
in the total or partial loss (or loss of use) of limb, finger, eye, or hearing,
you are entitled to received specific loss benefits – even if you never
missed time from work. Both disfigurement benefits and specific loss
benefits are payable in addition to standard wage loss benefits.
Section 7: Wage loss and specific injury benefits
Pennsylvania Workers’ Compensation Handbook | 33
What wage loss benefits am I entitled to under workers’ comp if I
am still working but am not making the same amount I did before
my work injury?
If you are partially disabled and return to work at reduced hours or
wages, you are entitled to receive two-thirds of the difference between
your pre-injury and post-injury wages under the PA Workers’ Comp Act.
Partial disability benefits are payable for a maximum of 500 weeks.
How are my wage loss benefits calculated?
Your compensation rate will be calculated by analyzing your wages
during the 4 three-month periods preceding the date of the work injury.
The compensation rate will be based on your highest quarterly earnings.
Your benefits will depend upon your average earnings during the four
highest thirteen-week periods preceding the date of injury. The average
weekly wage is calculated by averaging your earnings during the 3
highest thirteen-week periods. If you are a seasonal employee or have
worked less than 13 weeks, a different calculation method will be used.
There is a Pennsylvania statewide maximum rate of compensation.
Do wage loss benefits in PA reflect wage increases that I otherwise
would receive if I were working?
Wage loss benefits in PA do not reflect wage increases that you otherwise
would receive if you were working. Workers’ compensation benefits
are fixed as of the date of injury. The benefits will not increase as
time goes by.
Will my wage loss benefits in PA be reduced if I receive benefits
from other sources?
Unemployment - If you receive unemployment compensation for a
period of time which is later deemed to be covered under PA Workers’
Compensation, your employer will only be responsible for paying
Pennsylvania workers’ compensation benefits minus the amount
you received in unemployment. Nevertheless, you may apply for
unemployment while your workers’ compensation claim is pending
as long as you are able to work in some capacity.
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Social Security Retirement - If you begin receiving Social Security
retirement benefits after you sustain a work injury, your employer can
reduce your workers’ compensation in Pennsylvania by 50% of the
amount you are receiving in Social Security. This does not apply where
you are receiving Social Security retirement benefits before a work injury.
Severance - Employers may be entitled to reduce your workers’
compensation benefits in Pennsylvania if you receive severance benefits
while entitled to workers’ compensation.
Pension - Employers are entitled to reduce your PA workers’
compensation benefits by the amount of pension benefits payable by
the same employer, to the extent that the pension plan is funded by the
employer paying workers’ compensation benefits.
Am I entitled to partial workers’ compensation benefits if I am
working but not able to work overtime or my second job?
If you worked overtime during the year before your work injury and are
now working light duty or modified duty, you may be entitled to partial
workers’ comp benefits to compensate you for loss of overtime. If you
worked a second job at the time of your work injury, and you are not
able to work that second job because of your work injury, you may be
entitled to partial benefits to compensate you for your lost income.
What death benefits are available?
The dependents of an injured worker are eligible to receive death
benefits in Pennsylvania when a worker dies from: (1) a work-related
injury within 300 weeks of the time of injury or (2) an occupational
disease within 300 weeks of the time the worker was last employed in
the industry which caused the disease. The level of benefits depends on
the number of dependents who survived the injured worker and the
relationship between the dependents and the worker. Survivors also
receive reasonable burial expenses up to a maximum of $3,000.
Dependents do not automatically receive workers’ compensation death
benefits merely because the worker received compensation benefits
while living. Disability and death benefits are separate and any
claim for death benefits must be pursued by the dependents of the
deceased worker.
Pennsylvania Workers’ Compensation Handbook | 35
What medical benefits are available?
If you suffer from an occupational injury or disease, you are entitled
to reasonable and necessary medical treatment related to the injury
or disease, though The Workers’ Compensation Act limits the amount
that a medical provider will be paid. You are entitled to these benefits
regardless of whether any time is lost from work. Payment of
medical bills alone does not necessarily mean that your wage loss
claim has been accepted.
What workers’ compensation benefits are available if I suffer an
amputation or a permanent loss of use of a body part?
If you suffer the amputation or permanent loss of use of a body part,
you are entitled to receive weekly cash benefits for a specific number of
weeks at two-thirds of your pre-injury average wages. You are entitled
to receive specific loss benefits in Pennsylvania even after you return to
work. You may be entitled to additional benefits for a healing period
associated with treatment of the amputation or loss of use, provided
that you are not working during the healing period.
If you suffer partial or total hearing loss as a result of your employment,
you are entitled to receive hearing loss benefits which will vary,
depending upon the extent of your loss.
Examples of benefits available for loss of use: Hand 335 weeks; Thumb
100 weeks; Arm 410 weeks; Half of Thumb 50 weeks; Foot 250 weeks;
Big Toe 40 weeks; Leg 410 weeks; Index Finger 50 weeks; Eye 275
weeks
Am I entitled to any workers’ compensation benefits if I suffer a
burn, scar or disfigurement as a result of a work injury or disease?
If you suffer permanent burn, scar or disfigurement of the head, face, or
neck, you are also entitled to weekly benefits up to a maximum of 275
weeks. If a disfigurement claim cannot be resolved between the
parties, a workers’ compensation judge can be asked to review the
disfigurement claim and make a decision concerning the number of
weeks of compensation that you should receive.
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What are Sickness and Accident Benefits?
Sickness and Accident Benefits are benefits for total disability not
caused by work. Your employer may provide such benefits, but most
employers do not. Workers’ compensation benefits are far better
because Sickness and Accident benefits are payable in small amounts
and for a limited period. Furthermore, such benefits, unlike workers’
compensation benefits, are taxable. Finally, a workers’ compensation
insurance carrier is obligated to pay all medical expenses with no
limitations and no deductible.
When filling out a Sickness and Accident Benefits application, you may
be asked to state whether the disability was caused by work. If the
answer is yes, benefits may be denied. If the answer is no, such benefits
may be granted, but the workers’ compensation insurance carrier may
try to challenge your credibility in the workers’ compensation case. The
best answer is to write “the workers’ compensation insurance carrier
has denied my claim.”
Some Sickness and Accident insurance carriers will provide benefits for
occupational injuries or diseases if you promise, in writing, that you will
reimburse them if workers’ compensation benefits are granted.
Pennsylvania Workers’ Compensation Handbook | 37
Q. What happens if I never fully
recover from my work injury?
A. You are entitled to wage loss benefits as long as you
are disabled from work and to medical benefits as
long as you need medical treatment for your injury. If
you are released to light duty or modified work and
your employer does not offer you a position within
your restrictions, you will continue to receive total
disability benefits. While there is no specific limitation
on how long you can receive total disability benefits,
your employer has several tools available to attempt
to reduce or stop your disability benefits. These
usually begin when the insurance company
schedules you to attend an independent medical
exam. Partial disability benefits are payable for a
maximum of 500 weeks.
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What Social Security Disability (SSD) Benefits are available?
The Social Security Administration administers 2 disability programs:
Disability Insurance benefits and Supplemental Security Income.
Social Security Disability is a disability retirement program for seriously
disabled workers who have been contributing to the Social Security
Fund. It is not necessary for the disability to be related to employment
for you to be eligible for benefits. If you are eligible, you will receive
monthly benefits after a five-month waiting period. After 2 years of
receiving such benefits, Medicare coverage is available.
You are entitled to SSD benefits if you are suffering from a physical or
mental condition that prevents performance of any substantial gainful
work and the condition is expected to last or has lasted for at least 12
months, or is expected to result in death. Supplemental Security Income
is available to persons who have not made sufficient contribution to the
Social Security system to qualify for Social Security Disability Benefits.
The same disability test is applicable, but in addition, you must
demonstrate that you have only minimal liquid assets.
What unemployment insurance benefits are available?
You are eligible for unemployment insurance benefits if you leave work
“involuntarily,” have sufficient wage credit, and are “able and available
for work.” Employers sometimes argue that you cannot claim to be
“disabled” for workers’ compensation and “available for work” for
unemployment compensation. This is not correct.
Under the Unemployment Compensation Act, you are considered to be
able and available for work if you can engage in a wide range of work
activity. If you can perform sedentary work, you will be considered to be
“able and available.” Once you have been authorized by your physician
to return to restricted work, you should contact your employer and
offer to return to any position within the restrictions set forth by the
physician. If the company is unable or unwilling to provide employment
within these restrictions, you may be entitled to receive unemployment
compensation if certain requirements are met.
Section 8: Other benefits
Pennsylvania Workers’ Compensation Handbook | 39
Employers are entitled to a credit against your workers’ compensation
benefits for unemployment compensation benefits paid during periods
of disability.
Any unionized employee who seeks to obtain unemployment
compensation benefits should check with a union representative to
determine whether to do so. Many contracts provide that an employee
receiving workers’ compensation benefits will be entitled to continue to
accrue seniority, pension rights, medical benefits, vacation pay and
other benefits. Such benefits may not be available if the worker is
deemed to be “unemployed.” Accordingly, before an employee seeks
unemployment compensation benefits, he or she should check with his
or her union representative.
What veterans’ benefits are available?
The United States Veterans Administration provides pensions to
veterans with non-service connected disabilities which are total and
permanent. These pensions, however, are reduced by workers’
compensation, social security, and other benefits. PA also has a
limited Veterans’ Assistance Program which is administered by the
County Board of Assistance. If you are a veteran and have been
honorably discharged, you should contact the County Board of
Assistance to determine what benefits are available.
What pension benefits are available?
Any injured worker should check to see if pension benefits are available.
Typical pension plans provide for ordinary service connected disability
and non-service connected disability pensions. If you have reached
normal retirement age, you may be entitled to receive an ordinary
pension and workers’ compensation benefits. Usually pension plans
provide that the company is entitled to a credit against a disability
pension for all workers’ compensation benefits paid. You should
check with your personnel office to determine what pension benefits
may be available.
Section 8
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Are there additional benefits available to certain state employees?
Three statutes provide additional benefits to police officers and
firefighters and to certain state employees: The Heart and Lung Act,
Act 534, and Act 632.
1. Heart and Lung Act. The Heart and Lung Act applies to all state police
officers, enforcement officers or investigators employed by the
Pennsylvania Liquor Control Board, parole agents, enforcement
officers and investigators of the Pennsylvania Liquor Control Board,
or the Pennsylvania Board of Parole, any member of the Delaware
River Port Authority Police or any policeman, fireman, or park guard
of any county, city, borough, town or township who is injured in the
performance of his or her duties.
If you qualify, these benefits are available for any temporary incapacity
which results from a work injury. These benefits are also provided to
firefighters who, after 4 consecutive years of service or longer, suffer a
disease of the heart or tuberculosis of the respiratory system, contracted
or incurred and caused by extreme over-exertion in times of stress or
danger or by exposure to heat, smoke, fumes or gases, arising directly
out of covered employment. The Workers’ Compensation Act provides
that the employee is entitled to his or her full rate of salary until
the disability arising from employment has ceased. The Workers’
Compensation Act does not provide for compensation for
permanent incapacity.
2. Act 534. Act 534 covers any employee of a state penal institution or
correctional institution under the Department of Corrections and any
employee of a state mental hospital or youth development center
under the Department of Public Welfare. The Workers’ Compensation
Act covers injuries which occur during the course of employment by
an act of any inmate or any person confined in such an institution or
by any person who has been committed to an institution by any court
of the Commonwealth or by any provision of the Mental Health Act.
With respect to any employee of any County Board of Assistance,
the injuries are covered if they were incurred by the Workers’
Compensation Act of an applicant or recipient of public assistance.
Furthermore, any employee of the Department of Public Welfare who
has been assigned to or has volunteered to join the fire fighting force
of any institution of the Department of Public Welfare and who is
injured while engaging in firefighting duties is entitled to compensation.
Pennsylvania Workers’ Compensation Handbook | 41
Under Act 534, the injured employee is paid his or her full salary until
he or she is no longer prevented from returning as an employee of the
department, board or institution at a salary equal to that earned at the
time of the injury. Please note that benefits are also available for the
widow and widower and minor dependents of any employee who
dies within one year as a result of such injuries. Death benefits are
only available at the rate of 50% of the employee’s wages, but there
is no maximum statewide average weekly wage standard applied to
these benefits.
3. Act 632. Act 632 applies to a limited class of correctional institution
employees. If you believe you fall under this Act, contact our office for
more information.
Section 8
Willig, Williams & Davidson 1-866-413-COMP (2667)
Can I sue my employer because I was injured at work?
If you are injured at work, the only legal action you can take against your
employer is to make a claim for workers’ compensation benefits. You
cannot sue your employer for pain and suffering. If your work injury was
caused by a third party (not your employer or co-worker), you may have
the right to sue that person/entity for negligence and receive workers’
compensation benefits from your employer. a worker diagnosed with a
latent disease caused by exposures at work may be able to pursue a
negligence action against the employer.
If someone other than my employer caused my work injury, can I
sue them for negligence?
In a great number of situations, the worker’s injury was not caused by a
fellow employee or the employer, but rather by a “third party,” such as
the manufacturer of defective machinery. In each of those circumstances,
the worker may be entitled to receive workers’ compensation benefits
and bring a personal injury lawsuit for “pain and suffering” against the
negligent third party. Perhaps the most frequent occasion where the
Workers’ Compensation Act does not prevent a third-party suit arises
when an employee is injured in a car accident during work. If the other
driver is negligent and is not employed by the same employer, a personal
injury lawsuit may be brought.
In a factory setting, it is not unusual for injuries to arise as a result of
defectively designed machines. Often, industrial machinery is lacking
appropriate safety guards or similar devices. Usually the manufacturer of
the machinery is a company other than the employer and, therefore, can
be held legally responsible.
In many cases, workers are diagnosed with mesothelioma due to
asbestos exposure. These individuals can often sue for negligence.
In construction, an employee of one sub-contractor may be injured as
a result of the negligence of the employee of another sub-contractor. In
those instances, a personal injury suit is not barred. One whose work
takes him off the premises of his employer and onto the premises of
others is always exposed to the possibility of defective conditions at
Section 9: Suing for negligence and recovering penalties
for delays
Pennsylvania Workers’ Compensation Handbook | 43
those premises, defects that might serve as a basis for a negligence
claim.
These are just a few examples of situations where the Workers’
Compensation Act does not prevent you from pursuing an action for
pain and suffering. The point is that you should not simply assume that
suit is prohibited.
May I recover any penalties against my employer or the workers
comp insurance company if there is an excessive delay in payment
of my benefits?
Penalties under the Workers’ Compensation Act may be assessed
against an employer or its insurance company at the rate of 50% for a
violation of the Act or any unreasonable or excessive delay in the
payment of compensation. Attorney’s fees may also be recovered.
Where to Go for More Information
If you have questions and would like to
discuss a work injury or workers’
compensation claim with us, please feel
free to call Willig, Williams & Davidson
and our work injury lawyers at
1-866-413-COMP (2667) or 1-215-656-3600.
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Section 9
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Pennsylvania Workers’ Compensation Work Injury
Checklist & Notebook
If you have been injured at work, it is important to keep a record of how
you handled your work injury. You should keep copies of all relevant
documents together in one file and you should never sign a document
without reading and understanding it completely.
You should seek the advice of a certified workers’ compensation
attorney within 120 days of being injured or learning of a work-
related disease or illness. You should also seek the advice of counsel
if you have been denied workers’ compensation benefits, if you have
been asked to settle your workers’ compensation claim, and if you do
not believe your claim is being handled properly.
___ Report your injury as soon as possible (within 120 days of the injury).
Date of injury:
Location of injury:
Description of what happened:
Description of injuries (be specific):
List of all witnesses to the accident/injury (include contact
information and if possible, their statements):
Date injury was reported to employer:
To whom was injury reported (name and title):
If you stopped working, list the dates you were out of work:
Pennsylvania Workers’ Compensation Handbook | 45
___ Seek treatment from a panel doctor or provider for the initial 90
days of treatment.
Record the name and contact information of treating physician:
Record dates of all doctor visits and results of visits:
Record dates of all medical tests, type of test and results of test:
___ Note dates of receipt of formal workers’ compensation forms.
Notice of Compensation Payable:
Notice of Compensation Denial:
If receiving workers’ compensation, date it began:
After 90 days of treatment with the posted doctor, get your own
doctor. (Notify the adjuster of the change in doctor and keep the them
informed of your treatment.)
Record the name and contact information of new treating physician:
Record dates of all doctor visits and results of visits:
Record dates of all medical tests, type of test and results of test:
Willig, Williams & Davidson 1-866-413-COMP (2667)
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