When you suffer an injury at your job, or you are diagnosed with an occupational illness, it has serious consequences for your health as well as for your family’s financial situation, your career and your future. Fortunately, in Pennsylvania, an injured worker is eligible to receive workers’ compensation benefits.
These benefits will provide compensation for a portion of your lost wages, for any medical expenses associated with your work-related injury or illness and provide you with retraining if you need to find a new job. It’s important to note that workers’ comp benefits do not provide compensation for pain and suffering.
The idea behind the workers’ compensation program is to help both employees and employers. In the past, employees would need to sue their employers for any work-related injury. If the employee won the lawsuit, then they would receive an award for damages. But if they lost, they would receive nothing. On the other hand, employers could be sued by their employees. If they won, employers would owe their employee nothing, but if they lost, they could face potentially damaging litigation costs and awards.
Workers’ compensation is not perfect. Employees only receive partial compensation while they are injured, and employers are required to pay into the state’s workers’ compensation insurance program even if their workplace is injury free. In the long run, however, the program is a benefit to both employers and employees.
Pennsylvania Workers’ Comp Process
Workers’ compensation in Pennsylvania is a no-fault system. That means it does not matter if your injury or illness is a result of your own carelessness or your employer’s — you are still eligible for compensation. Employees no longer need to wait to see if they will win a court case before they receive any compensation for their injuries, and employers no longer face the possibility of a damaging payout if they lose a lawsuit.
If you are injured on the job or are diagnosed with a work-related illness, you have 120 days to notify your employer. However, you shouldn’t wait this long. The first thing you need to do if you are injured on the job is to seek immediate medical attention. Then as soon as you can, notify your supervisor or your employer immediately that you have suffered a work-related injury. If you are diagnosed with an occupational illness or injury, such as a repetitive stress injury, you should also notify your employer of this illness or injury as soon as possible.
If you notify your employer within 21 days of suffering an injury or being diagnosed with an illness, you will receive benefits dating from the actual injury or diagnosis. If you wait longer than 21 days but still report it within 120 days, then you will receive benefits from the day you reported the injury or illness.
After you report your illness or injury to your employer, they have three days to file a First Report of Injury (FROI) to the Bureau of Workers’ Compensation in Pennsylvania. Your employer is also required to notify their insurance carrier that you have been injured. The insurance carrier then has 21 days to decide whether to accept or to deny your workers’ comp claim.
If the insurance carrier accepts the report of your injury, you will begin to receive workers’ compensation benefits. If they decide not to pay the workers’ compensation benefits, and you feel they have made a mistake, you have three years from the date of injury or diagnosis to file a workers’ compensation claim petition with the Bureau. If your appeal is successful, you will begin to receive workers’ compensation benefits. There are also other levels of appeals if your claim is denied.
There are several types of workers’ compensation benefits in Pennsylvania, depending on the length and the severity of your injury or illness.
Pennsylvania Workers’ Compensation Payments
Pennsylvania workers’ compensation covers several important areas.
1. Wage-Loss Benefits
Wage-loss benefits provide compensation for two-thirds of your average weekly wage. There are both minimums and maximums to how much you can receive for your average weekly wage. The length of time that you will receive wage-loss benefits depends upon the severity and the length of your injury or illness.
2. Medical Expenses
Workers’ compensation benefits will cover all necessary and “reasonable” medical expenses related to your work injury. Reasonable medical expenses include surgery and visits to specialists. Out-of-the-ordinary medical treatments, however, may not be covered.
3. Specific Loss Benefits
If your injury has resulted in you permanently losing the ability to use certain body parts or in serious disfigurement of your face, head or neck, you are eligible to receive specific loss benefits. You will receive two-thirds of your average weekly wage for a certain number of weeks depending upon which area of your body has been injured. The number of weeks of compensation you will receive for each permanently disabled body part or disfigurement is outlined in a schedule of awards determined by the state and the Bureau of Workers’ Compensation.
If it is necessary for you to travel for an Independent Medical Exam but most travel for you medical treatment isn’t covered.
5. Vocational Rehabilitation
If your injury means you can no longer return to your previous job, workers’ compensation benefits will pay for vocational rehabilitation to help you find a new job.
6. Death Benefits
If you are killed on the job or if your injury or illness results in your death, your spouse and children are eligible to receive death benefits. This amount will be determined by how many dependents claim benefits.
7. Funeral Expenses
As of late 2018, the amount of money available for funeral expenses for a worker who was killed on the job or died as a result of a work-related illness or injury is $3,500.
How Are Wage Loss Benefits Calculated?
Injured workers who have been off their jobs for more than seven days will start to receive workers’ compensation wage loss benefits. These first seven days will not be paid, however, until you have been off the job for at least 14 days. Workers will then be paid for the first seven days as well.
Wage loss payments are classified in different ways — total or partial:
- Total disability means that the injured worker cannot work at any kind of a job. They are completely disabled.
- Partial disability means that the employee can no longer work at their previous job but can still work in a less strenuous job.
1. Total Disability Benefits
You receive two-thirds of your average weekly wage when you are receiving total disability benefits. You determine your average weekly by using the State Average Weekly Wage (SAWW) table.
Here is a summary of the SAWW for 2019:
- If your weekly wage is between $1,573.50 and $786.76, you will receive two-thirds of this amount up to a maximum of $1,049.
- If your weekly wage is between $786.75 and $582.78, you will receive $524.50 in wage benefits.
- If your weekly wage is $582.77 or less, you will receive 90 percent of this in weekly compensation.
To value your wages correctly, you need to include:
- your gross wages if they are fixed by the week
- any federally reported gratuities
- prorated annual vacation pay
- anything your employer pays you for weekly board or lodging
It is extremely important that you calculate this figure correctly. When you begin to receive wage-loss workers’ compensation benefits, your employer will send you a Statement of Wages form. It is crucial that you review this with your attorney to make sure that your wages are calculated correctly. A mistake could cost you hundreds or thousands of dollars in benefits.
You will continue to receive these benefits for 104 weeks or until you reach Maximum Medical Improvement (MMI). This is the point at which your doctor determines that you will not recover from your injury or illness any further. When you reach the 104-week total, your employer’s insurance company will require you to undergo a medical examination known as in Impairment Rating Evaluation (IRE).
- These evaluations are extremely controversial in part because the insurance carrier gets to select the doctor who conducts the evaluation. At one point, IREs were ruled unconstitutional by the Pennsylvania Supreme Court. In late 2018, however, the Pennsylvania legislature reached a compromise and restored the requirement to take an IRE.
- If the doctor conducting the examination finds that you are 35 percent or more disabled, then you are considered totally disabled, and you will continue to receive benefits until you die.
- If the doctor, however, finds that you are less than 35 percent disabled, you are now considered partially disabled. This means that you may only collect your benefits for a limited amount of time — 500 weeks. Your rate will remain the same.
2. Partial Disability Benefits
These benefits are calculated by taking the difference between what you earned in your previous position and what you are earning now and paying you two-thirds of that total in benefits. You will continue to receive partial disability benefits for up to 500 weeks (about 9.6 years).
You will receive partial disability benefits until your doctor feels that you can return to work. Often returning to work involves medical restrictions on what you can and cannot do. If you returned to work in a new position that pays less than your previous position did, you would continue to receive some workers’ compensation benefits.
You will receive partial disability benefits if you are injured but ultimately able to return to your employer’s business, even if you must take a position where you will be earning less than you did previously, or if you receive an IRE rating of less than 35 percent.
Specific Loss Benefits
Another form of workers’ compensation benefits is specific loss benefits. These benefits are paid to you when you have lost total or partial use of certain body parts – arms, legs, ears eyes, hands or feet – or if you have suffered serious disfigurement of your face, head or neck. These awards are based on a schedule determined by the state.
For instance, if you have complete lost the use of an arm, you can be compensated for up to 410 weeks at two-thirds of your average weekly wage. So if your average weekly wage was $700, you would be eligible for a specific loss benefit of up to $191,429.
It should be noted that if you’ve already received temporary disability benefits, these payments can be deducted from your final award.
This is training for a new job. Your employer is obligated to pay for any retraining costs under workers’ compensation. You will continue to receive your workers’ compensation benefits until you find a new job. You need to be careful, however, because often your employer and their insurance company will try to use vocational rehabilitation as a way to stop paying you for other workers’ comp benefits. If you feel that you are being forced into job retraining before you are ready, contact an experienced workers’ compensation attorney immediately.
If a worker is killed on the job or dies as a result of their work-related injury or illness within 300 weeks (about 5.7 years) of being injured or being diagnosed with an illness, their children and spouse are eligible to receive death benefits.
The benefits are determined by the average weekly wage of the deceased worker, the number of beneficiaries and the percentage of your relationship with the deceased worker.
For instance, a spouse with no children will receive 51 percent of the deceased worker’s average weekly wage.
A surviving spouse who is the guardian of the deceased worker’s children will receive a higher percentage of the deceased worker’s average weekly wage depending on how many children there are. If there is only one child, the spouse will receive 60 percent of the average weekly wage. If there are two or more children, the spouse will receive two-thirds of the average weekly wage. It is a benefit for both the spouse and children. The spouse will continue to receive benefits unless they remarry. Children will continue to receive benefits until they turn 18 or until they are 23 if they are enrolled in an accredited college or institution of learning.
There are also potential benefits for several other situations including children with no spouse, no children or spouse, and no surviving spouse, children or parents. If you think you may fit into one of these categories, you should speak immediately with a workers’ compensation attorney.
If You Have Questions About Your Workers’ Comp Benefits, Contact Calhoon and Kaminsky P.C.
Determining how much you should be receiving in benefits can be a complicated issue. You need to have a solid understanding of your average weekly wage and the severity of your injury or illness. Trying to determine all these factors on your own can be frustrating and even cost you benefits to which you should be entitled.
At Calhoon and Kaminsky P.C., we focus only on workers’ compensation. We are familiar with almost every situation involving an injured worker and can help you determine what benefits you are entitled to receive and the amount of those benefits. If you are the survivor of a deceased worker who has died as a result of a work-related injury or illness, you should also speak with one of our attorneys to ensure that the worker’s survivors are financially protected.
You can contact us for a free consultation. You can call us toll-free at 877-291-9675 or 717-695-4722 or visit our contact us page where you can leave us your information and tell us something about your work-related injury or illness. We will be in touch as soon as possible.