Pennsylvania Workers’ Compensation: An Overview
Originally passed in 1915, the Pennsylvania Workers’ Compensation Act is a state-wide, no-fault insurance system of benefits designed to compensate all injured workers for lost wages and medical expenses. The system was not designed to replace all of the wages lost by the injured worker, but only a percentage of those wages in a non-taxable form of weekly or bi-weekly benefits. The Workers’ Compensation Act does not provide for non-economic damages such as pain and suffering. It pays for all injuries and occupational diseases that occur during the course and scope of one’s employment.
It is extremely important for you to know your rights when it comes to workers’ compensation benefits. Your rights to receive workers’ compensation benefits begin the moment you are hired. Workers’ compensation applies to all employees, regardless of the number of workers employed, and it includes volunteer firemen, rescue workers, state park and forest workers and anyone else who performs services in exchange for wages in this Commonwealth, including immigrants.
The only recourse an employee has against his or her employer when injured on the job is through the Workers’ Compensation Act. Employees cannot sue their employers in the event of a work-related injury. Pennsylvanians gave up a constitutional right to sue for damages after a work injury. In return, they were guaranteed payment for lost wages and medical expenses, while their employers were freed from the ramifications of varying settlement amounts.
The Workers’ Compensation Act applies to ALL injuries or occupational diseases occurring during the course and scope of employment and which are related to that employment. The Act applies to all Pennsylvania injuries and even injuries occurring outside of Pennsylvania under certain circumstances. The Act applies even if you have a pre-existing condition, known or unknown to your employer. If you have a bad back or heart condition and you aggravate, accelerate, or in some way worsen that condition, you are entitled to collect workers’ compensation benefits from your present employer.
Negligence, either your own or your employer’s, does not prevent you from collecting workers’ compensation benefits. Therefore, if your employer tells you that your claim is being denied because of a pre-existing condition or because your injury was “your own fault,” it is NOT TRUE— seek out an attorney. It is your absolute right to receive workers’ compensation benefits even though you had a prior condition or were at fault in bringing about your injury.
Also, if your injury or occupational disease results in death, certain members of your family may be entitled to collect workers’ compensation. For example, a widow, widower or other dependent who was dependent upon the injured worker at the time of death would be permitted to collect workers’ compensation benefits at a percentage of what the worker would have collected until that widow or widower remarries.
Generally, if you are injured either on your way to or coming home from work, you are not covered by the Workers’ Compensation Act. However, if your job requires you to travel, you have no fixed place of employment, or you are under a contract that covers you while on your way to and from work, you may be covered. Also, if you are injured in a parking lot owned or supplied by your employer, you may be covered. These issues are very “fact specific,” and you need the advice of an attorney to assist you in determining whether you have a workers’ compensation claim, a civil lawsuit, or both.
Employees covered under Pennsylvania workers’ compensation
Any employee who was injured in the state of Pennsylvania is covered under the Pennsylvania Workers’ Compensation Act – period. An employee is any person who performs services for another for valuable consideration (money). It doesn’t matter if your job is part-time or seasonal in nature. Members of volunteer organizations such as fire departments and rescue squads are considered employees as well. Federal government workers, military personnel, railroad workers, maritime workers, and national guard members are all covered under separate and different statutory compensation laws. Longshore and harbor workers can be covered under both the Pennsylvania Workers’ Compensation Act and the Longshore and Harbor Workers’ Compensation Act in certain cases, but for the most part, these workers are covered under the Federal Workers’ Compensation Act.
As soon as you are injured on the job, you should report the injury to your employer, even if the injury does not cause you to miss time from work. We suggest that the notice be given in writing, but if that’s not possible remember that you, or someone acting on your behalf, must report that you were injured and that your injury was caused by your job. Also, even if you only suspect that you may have an occupational illness, you should report it. The injury must be reported to your supervisor or the person whose job it is to prepare injury reports.
By law, you have 120 days to report an injury to your employer. The time begins from the date of your injury or the date you knew or should have known of an occupational illness or disease. If you do not provide notice within 21 days, you will not be entitled to recover workers’ compensation benefits until the date that you actually give notice, as long as notice is given within 120 days. Failure to give notice within 120 days will bar you from collecting any workers’ compensation benefits.
Total disability benefits
Total disability benefits are payable for as long as you are unable to work. There are no specific time limits imposed by law to collect these benefits. However, after you have collected total disability benefits for two years (104 weeks), you may be asked to undergo an Impairment Rating Evaluation (IRE) by the workers’ compensation insurance carrier.
If, as a result of the examination, you are found to have less than a 50% whole body impairment, the amount of time you can collect total disability benefits is limited to a maximum of 500 weeks, and you will be considered “partially disabled.” Your benefit rate, the amount that you collect per week, however, will remain the same. The workers’ compensation insurance carrier can still attempt to reduce your partial disability benefit further through vocational rehabilitation during the 500 weeks of partial disability.
Partial disability benefits
Partial disability benefits are payable up to 500 weeks (9.6 years) when your partial disability status is determined from an IRE or if an insurance carrier’s doctor feels that you are able to perform light-duty work. This means that you have the ability to earn some wages, but you have not completely recovered from your work injury.
If the new job pays less than the pre-injury job, you are entitled to be paid two-thirds of the difference between average weekly wage of your old job and your new job up to the maximum rate for the year of your injury.
Specific loss benefits
Specific loss benefits are payable if you suffer an amputation or loss of use of various body parts, such as fingers, hands and toes. If you suffer a loss of hearing or vision, you are entitled to be paid specific loss benefits also. Any permanent or serious disfigurement (scars) of your head, neck or face, entitles you to receive specific loss or scarring benefits. Payment for specific loss benefits are equal to your total disability benefit rate for the time period and the healing periods.
Your employer is required to pay for any reasonable, necessary and related medical care that you obtain for your work injury. This may also include costs of home or automobile renovations to accommodate a seriously injured worker. There are no time limitations or restrictions on receipt of medical care for your work injuries.
Travel expenses to and from medical providers generally are not reimbursable under the Pennsylvania Workers’ Compensation Act. However, if you have to travel outside your local community for treatment that is not available in your community, then you may be entitled to reimbursement of travel expenses.
An insurance carrier is required to provide transportation to and from an Independent Medical Examination if you cannot get there on your own.
If a worker dies as a result of a job injury or illness within 300 weeks of the date of injury or date of last exposure to the health hazard, the worker’s family is entitled to receive $3,000 in funeral expense reimbursement and the widow or widower is entitled to collect compensation until he or she remarries. The children of the deceased worker are also entitled to receive compensation until they turn 18 (or until age 23 if they are enrolled as full-time students in an accredited school). The amount of death benefits payable to the surviving spouse and/or children is a percentage of what the deceased worker would have been entitled to receive as total disability benefits.
Recent changes in the PA Workers’ Compensation Act
The laws governing workers’ compensation were dramatically changed on June 24, 1996. Those amendments (more commonly known as Act 57) made it more difficult for the injured worker to be paid benefits and gave employers more control over injured workers. The laws governing workers’ compensation were once again amended on November 9, 2006, through Act 147, with the intent to help injured workers in Pennsylvania.
Every employer in the Commonwealth of Pennsylvania is required to carry workers’ compensation insurance. Some employers are self-insured, which means that they have to post a bond and pay benefits out of their own bank accounts. Through Act 147, the Uninsured Employers Guaranty Fund was established to pay a claim brought under the Pennsylvania Workers’ Compensation Act or Occupational Disease Act, where the employer liable for payment has failed to insure or self-insure themselves at the time of the injury.