Understanding the Average Workers’ Comp Settlement in Pennsylvania
The average workers’ comp settlement in Pennsylvania varies greatly from case to case. Factors that influence what someone receives include the type of injury, their disability rating, and how quickly they file their claim. Likewise, people may receive a set amount if they suffer a specific loss (e.g., an amputated thumb) named in the workers’ compensation law. Additionally, they may miss their deadline if they wait too long to file their claim. If this happens, they may not be able to receive any benefits. Workers can increase their chances of receiving a fair settlement by taking swift action to protect their legal rights and following their doctor’s recommendations.
At Krasno, Krasno & Onwudinjo, we have been fighting for Pennsylvania workers since 1936. During that time, we’ve helped injured employees recover a combined $1.5 billion in compensation, connecting them to the critical funds they need to get their lives back. Our experienced Pennsylvania workers’ compensation lawyers champion the rights of injured employees, from truck drivers to manufacturing workers, teachers, cashiers, construction workers, and everyone in between.
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What Benefits Might Be Included in the Average Workers’ Comp Settlement Package?
Workers’ compensation benefits exist to help injured employees support themselves while they heal from their conditions. Possible forms of compensation include medical care, wage replacement benefits, death benefits, or money for specific losses.
Under Pennsylvania’s workers’ compensation laws, hurt employees can receive benefits to recover their injury-related medical treatment. This portion of the settlement might include reimbursement for things like:
- Emergency medical care,
- Rehabilitative therapy, and
- Prescription costs.
In other words, it may be covered if the worker can show that it is reasonable, necessary, and relates to the job injury. Additionally, if the person acquires an occupational disease like cancer, their compensation may account for chemotherapy or other ongoing treatments.
What healthcare provider the worker sees can also impact their settlement. Sometimes, hurt employees have the right to see their preferred physician, but this isn’t always the case. For example, as the Pennsylvania Department of Labor and Industry explains, if your employer accepts your claim and posts a list of six physicians, you may need to see one of these doctors (at least for the first 90 days). If (without authorization) you see a provider not on the list during this initial period, you may be on the hook for the expenses. After 90 days, you may be able to see a doctor of your choice. But before you do, notify your employer to ensure coverage.
Employees injured at work may also be eligible for lost wages to cover lost earnings. The amount of these benefits depends on the person’s impairment rating, their average weekly wages, and whether they can return to work.
The default rule is for workers to receive 66 and two-thirds percent of their average weekly pre-injury earnings. But sometimes, this figure may be adjusted to a lower or higher amount. For example, if their weekly benefits are less than 50 percent of the statewide average weekly wages, they might be entitled to up to 90 percent of their pre-injury earnings.
What wage replacement benefits they receive and for how long depends on their impairment rating. For example, someone with a total disability might receive their benefits for 104 weeks. At that time, the doctors would reevaluate them to determine if they have improved or can return to work. Depending on the outcome of that assessment, they may receive additional benefits, or their benefits might start to taper off (or stop altogether).
Benefits for Specific Losses
If someone experiences a specific loss outlined in Section 306(c) of the Pennsylvania workers’ compensation statute, they may receive a set amount. For example, someone who loses a leg may be eligible for 66 and two-thirds percent of their average weekly wages. If they choose to receive weekly payments, these benefits may last for 410 weeks. Those who are eligible for this category of compensation may be ineligible for other benefits. The wage replacement settlement they receive may be based on their pre-injury weekly earnings. But if this is less than 50 percent of the statewide average weekly wages, the base pay may be increased.
If a worker succumbs to their injuries, their surviving family members may be entitled to death benefits. The specific amount of this settlement depends on the person’s relationship to the employee who passed away. For example, let’s say the worker was married and didn’t leave children behind. In that situation, their surviving spouse may get one-half of the worker’s pre-injury weekly wages. But if this is higher than the statewide weekly average, it may be reduced accordingly.
How Much Is the Average Workers’ Compensation Settlement?
The Pennsylvania Department of Labor and Industry’s 2022 Workers’ Compensation and Workplace Safety Report indicates that approximately $2.68 billion was paid out in Pennsylvania workers’ comp claims in 2021. Of that sum, about $1.2 billion went toward medical compensation, and the other $1.46 billion went to indemnity (e.g., wage loss) costs.
According to the National Council on Compensation Insurance’s (NCCI) most recent national data, the average cost per work injury claim in the United States was $41,353 in 2019 and 2020. This figure includes the cost of medical care, wages, and other losses that stem from the work injury in participating states. The NCCI’s numbers include data from all reporting states, not just Pennsylvania, and encompass a wide range of injuries. So, people shouldn’t take this as a guarantee of what they might receive after a work injury.
The exact settlement an individual worker might get in a particular case depends on factors such as:
- Their impairment rating,
- The severity of their injury,
- Whether they file their claim on time,
- The cost of their medical care, and
- The employee’s average weekly wages before the injury.
Additionally, if the employee suffers a specific type of loss, they may receive a set amount based on the current Pennsylvania law. For example, losing a hand may entitle the worker to wage replacement benefits of 66 and two-thirds percent of their wages for 335 weeks.
Finally, keep in mind that many workers’ compensation settlements are the product of negotiations between the employee, their employer, and the insurance company. Because of this, the progress of these talks can influence the outcome.
For example, if the insurance company is reasonable, fair, and responsive to the employee’s requests, the employee might receive a higher amount. But if the insurance company plays hardball or repeatedly denies the worker’s request, it can make it more difficult for them to reach a fair agreement. In those cases, the employee can take legal action (such as appealing the decision) to help increase their chances of getting the settlement they deserve.
Examples of Average Workers’ Compensation Settlements By Body Part
The NCCI’s 2019-2020 report (cited above and published in 2022) gives national averages of workers’ compensation settlements based on data from participating states. According to this data, a head injury or damage to the central nervous system carries the highest average cost. In 2019-2020, this type of injury had an average cost of $60,875 in healthcare expenses and $33,067. If multiple body parts were injured, the average compensation rate was $32,647 (medical) and $30,212 (wage loss). A leg injury typically costs $38,049 in medical expenses and $21,699 in wage loss. Finally, the average cost of an arm or shoulder injury totaled $20,688 (medical) and $23,028 (lost earnings).
Keep in mind that these figures are averages based on a limited data set for many different states. Likewise, each case is unique and may call for a different outcome based on the law in effect. So, what was true in one situation does not mean it will be the same in another. The best way for someone to estimate their workers’ compensation package is to perform a live calculation with the help of an attorney.
Factors That Influence the Average Workers’ Compensation Settlement Amount
Unless someone experiences a specific type of injury, the workers’ compensation settlement package they receive varies from case to case. What someone gets in benefits depends on factors like the following:
- Their impairment rating,
- When they file their claim,
- If they return to work,
- The type of loss or injury, and
- How they receive their settlement.
Each factor can play a greater or lesser role in a case, depending on the unique situation. For example, someone who suffers a specific loss may receive a set amount, regardless of their disability rating. In contrast, if someone has a total disability but returns to work, they might receive less or lose their benefits entirely.
The Worker’s Impairment Rating
In most cases, the disability rating doesn’t directly impact the base pay someone receives. In other words, it doesn’t change the weekly earnings calculation. But it can affect the length of time someone receives their benefits. For example, someone with a partial disability rating might receive a total of 500 weeks of wages. However, someone with a total disability might receive benefits for as long as they have an impairment rating of 35 percent or more.
Whether the Employee Filed Their Claim on Time
Workers must file their claims within a specific timeframe. In many cases, they must tell their employers about their work injury within 21 days of it happening. The maximum amount of time they have to submit a claim is within 120 days. The clock begins either on the day they got the injury or when they discover their job caused their occupational disease. For example, if a construction worker is exposed to asbestos and develops mesothelioma, they may have to submit a claim within 120 days after they receive the diagnosis.
People filing claims for occupational diseases have to meet other requirements. For example, as the Pennsylvania Department of Labor and Industry explains, the employee needs to have worked with that Pennsylvania employer for at least two years during the 10 years before their injury.
Workers who fail to file their claim on time may forfeit their right to compensation. But there are exceptions in which this may not be the case. Employees with questions about when to file a claim and how to do this can talk to a workers’ compensation lawyer who can help.
Returning to Work
Workers who return to their job (or start another position) while receiving workers’ compensation may get fewer benefits or lose their right to it entirely. In some situations, the worker might receive a percentage of the difference between their pre- and post-injury wages. But this isn’t always the case.
Employees considering returning to their jobs might benefit from talking to a lawyer for workers’ compensation. If the worker’s doctor gives them clearance to return to work, this can change their eligibility for benefits. Of course, if the employee disagrees with their doctor’s findings, they may get a second opinion.
The Type of Loss or Injury
Another factor influencing the average workers’ compensation settlement package is the type of loss or injury the employee experiences. For instance, someone with a severe injury that totally disables them may have higher medical expenses than someone with a minor cut or bruise. In turn, the total amount they receive in medical or wage replacement benefits might be more. Likewise, someone who experiences a specific type of loss (like an amputated foot) would receive a pre-determined amount of compensation.
How the Worker Chooses to Receive Payment
In some cases, employees can get their benefits in one lump sum payment or in periodic payments (usually weekly or bi-weekly). If they choose the lump sum payment option, this may limit their ability to request more funds later on if their condition worsens. In contrast, if they receive periodic payments, they might retain the right to adjust their benefits payment in the future. A situation in which this might come up is if the worker gets a second job-related injury.
How Does Your Impairment Rating Impact Your Workers’ Compensation Settlement?
Part of the way insurance companies decide how much people get in compensation (and for how long) is the person’s impairment rating. A qualified doctor assigns this rating based on how much they believe the injury impairs the worker’s functioning. For example, an impairment of 35 percent or more is a total disability. In contrast, if 34 percent or less of the worker’s functioning is affected, they receive a partial disability rating.
Someone’s impairment rating can change as they heal. For example, in the days or weeks following an injury, the worker might be totally incapacitated. During this time, they may have a total disability rating and receive benefits accordingly. But as they heal and, hopefully, regain their abilities, their function level might improve. As a result, the doctors might give them a partial disability rating.
Someone’s impairment rating may not directly impact what they receive in medical benefits. In other words, their rating may entitle them to wage-loss benefits for a particular length of time. But they may also receive compensation for their medical expenses. Someone with a total disability may require more medical attention, meaning they might receive more to cover these costs. But their impairment rating, on its own, isn’t what determines this.
What Can You Receive for Total Disability?
A settlement for a total disability might include wage replacement benefits of at least 66 and two-thirds of your average weekly earnings. As described earlier, the insurance company may adjust this amount to ensure you receive the lesser of 50 percent of the statewide average or 90 percent of your weekly earnings. Under the Pennsylvania workers’ compensation law, your first check might arrive after the seventh day of your disability.
You may continue to get these benefits while you have a total disability. However, the insurance company may ask a doctor to reevaluate you again after 104 weeks. If you get a lower impairment rating this time, you may receive partial disability benefits. If not, your total disability benefits may continue. You should receive a 60-day notice before the insurance company changes your benefits.
Please note that if you experience a specific type of permanent loss, this section may not apply to you, even if you have a total disability. For example, someone who loses a thumb receives a set amount of money for a particular length of time. This might be true regardless of their impairment rating.
What Can You Receive for a Partial Disability?
If you have a partial disability, you might receive 66 and two-thirds of the difference between your pre-injury wages and what you can earn with the injury. The insurance company might reduce this figure to be less than 66 and two-thirds of the statewide average weekly wages. If this happens, your wage replacement benefits may be 50 percent of the statewide average or 90 percent of your wages, whichever is less.
In most cases, the maximum amount of time you may receive partial disability benefits is 500 weeks. If your condition worsens and renders you totally disabled, your status may change accordingly. Often, this won’t impact the amount you receive in compensation. However, you may undergo periodic evaluations to see if your condition improves.
Estimating Your PA Workers’ Compensation Settlement
The two main components of a work-injury compensation package include payments for medical care and lost earnings. If the worker dies because of their injuries, eligible, surviving family members (e.g., spouse or children) may receive wage replacement benefits for a set amount of time. For more information on estimating settlement packages for job-related injuries, you can also check out this workers’ compensation calculator.
Estimating Your Medical Care Costs
The workers’ compensation laws require your employer (or their insurance company) to pay for all reasonable, injury-related medical costs. This might include the following expenses:
- Doctor’s visits (with approved providers),
- Prescription medications,
- Physical therapy, and
- Medical supplies.
You may receive these benefits even if you don’t lose time off work (although the amount of coverage might vary). According to the Department of Labor and Industry, your qualified medical expenses may be covered for as long as you need it. Make sure you save copies of all your after-visit summaries and other medical records. You can use this to help support your benefits claim and track your progress.
Calculating Your Average Weekly Wages
The wage replacement benefits you receive are based on your average pre-injury earnings. Your weekly wages include your salary, monthly base pay, or hourly rate (however you receive payment). Likewise, things like lodging and tips are part of your wages. But your wages don’t include fringe benefits, like employer retirement contributions, life insurance, social security, or pension payments. Other forms of compensation, like vacation pay and annual bonuses, might be included. If so, you might add these separately and divide them by 52. Then, you add this number to the weekly wages you calculated above.
If your average weekly wages are less than one-half the statewide average, you use another method to calculate your weekly earnings. You might receive the lesser of either 50 percent of the statewide average or 90 percent of your average weekly wages. The maximum someone can receive is based on the statewide weekly average. According to the Department of Labor and Industry’s 2023 statewide average weekly earnings data, the maximum weekly compensation rate is $1,273.
Please note that there are special rules about calculating your wages if you haven’t been working for your employer for long. Additionally, seasonal workers would use a different formula.
Krasno, Krasno & Onwudinjo: We Can Help You Estimate Your Workers’ Compensation Settlement
Being unable to work because of a job-related fracture, occupational disease (like tuberculosis), or other conditions can create a lot of uncertainty in your life. You might worry about being able to pay rent, afford groceries, and keep your job. Without knowing what to expect in compensation (and how to get it), you may feel lost, confused, and frustrated. But there’s hope.
At Krasno, Krasno & Onwudinjo, we’re here to help you find answers to questions you have and ones you may not know to ask. While our team can’t guarantee a particular outcome, what we can do is help you estimate what you might receive in compensation. We can also help you file your claim on time and represent you throughout the entirety of the claims process. We’ve successfully handled over 300,000 claims in Pennsylvania, equipping workers with the vital assistance they need to move forward.
If you have a job-related injury and want to know the average workers’ compensation settlement in cases like yours, call us at 844-948-2338 or contact us online to schedule a free, no-obligation consultation.