How Does Workers’ Compensation Work? (In Simple Terms)
Workers’ compensation can be complicated, but it should not be. Filing a claim should be an easy process for employees, and the employer should assist in any way possible. The most important thing to remember about a workers’ compensation claim is notice. Always give notice as soon as you are aware of the injury to the employer to ensure proper coverage for your injuries and lost wages.
When filing an initial claim or handling a denial, an experienced workers’ compensation attorney can help ease the process. An attorney will know who to speak with and how to get you the maximum benefits and compensation for your injuries. After giving notice of an injury, consider contacting the Pennsylvania workers’ compensation attorneys at Krasno, Krasno & Onwudinjo to help expedite the process and reduce stress.
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Overview of Workers’ Compensation
Workers’ compensation in Pennsylvania allows employees to collect compensation when they are injured at work. Employees’ rights are protected under the Pennsylvania Workmen’s Compensation Act, which outlines the administrative and appeal processes, as well as what benefits an employee can collect when injured at work.
Typically, when an employee is injured while on the job, they can file a workers’ compensation claim to receive pay for lost wages and any medical treatment related to the injury—this can include emergency costs, surgical costs, therapy, pharmaceuticals, and other medical procedures and treatments.
While each state is different on workers’ compensation mandates, Pennsylvania is one of many that requires employers to have workers’ compensation coverage. If an employer is found to not have the proper coverage, they can face grave penalties, including both civil and criminal lawsuits.
All employees will be covered by workers’ compensation insurance during the entire time of employment, starting day one. Even if a worker was injured at a past job or has a previous medical condition, they will not be barred from workers’ compensation coverage. If an employee is injured while on the job, then they will be covered.
The requirements for any workers’ compensation claim are simple, if the employee was employed and actively on the job at the time of the injury, then they can file a claim for workers’ comp benefits.
Filing a Workers’ Compensation Claim
Filing a workers’ compensation claim can be cumbersome and require a bit of paperwork. Luckily, the Pennsylvania Department of Labor and Industry tries to make the process straightforward by placing all necessary forms and claim information in one convenient location.
First and foremost, when injured at work, the number one requirement is to give notice to your employer. Once the employer receives notice, they are required to provide the name, address, and phone number of their worker’s compensation insurance coverage/company. Additionally, they are required by law to post form LIBC-500, which is a notice or injury report form. This allows the employee to properly give notice of their injury.
An employee is required to report the injury within 21 days and if not reported within at least 120 days from the date or from when the employee gained knowledge of the injury, then they will not be able to collect workers’ compensation benefits.
Employers are also required to report the injury to the insurance company upon notice. If the injury resulted in death, employers have 48 hours to file a First Report of Injury and if the injury resulted in a disability lasting more than one day or one shift, then they have 7 days to file the First Report of Injury.
No later than 21 days after the notice and reporting the claim, the insurance provider will either deny or grant the workers’ compensation claim. If the claim is denied, then the case is closed. The employee still has options through the litigation system, like filing a Claim Petition, if the claim has been denied. This will reopen the case and allow for an administrative hearing.
An employee can receive notice of temporary compensation while a claim is still being instigated. This allows an extra 90 days to review the claim. Once they have made their decision, the employee will receive notice that either the pay will be stopped or that they will be receiving full workers’ compensation pay for the injury.
Compensation will be based on the employee’s current pay and the costs of injuries. The employee will receive compensation for their injuries until they receive a notice of suspension, notice of medication, or a final statement with receipt.
How Much Does Workers’ Compensation Pay in Pennsylvania?
The maximum amount of workers’ compensation benefit/pay an employee can receive is based on the Department of Labor and Industry’s calculation of average weekly wages.
The pay will vary based on the worker’s current compensation and what year the claim was filed. Generally, workers should receive compensation benefits equal to two-thirds of their weekly pay. There are state minimum and maximum pay amounts set forth by the Workers’ Compensation Act.
- Claim filed after January 1, 2019: maximum of $1,049.00 weekly
- Claim filed after January 1, 2020: maximum of $1,081.00 weekly
- Claim filed after January 1, 2021: maximum of $1,130.00 weekly
- Claim filed after January 1, 2022: maximum of $1,205.00 weekly
- Claim filed after January 1, 2023: maximum of $1,273.00 weekly
The average weekly pay is based on the total gross wages made at the time of the injury, which includes average overtime, tips, and bonuses reported. This can include typical expenses that an employer might pay, like housing and vehicle payments.
Looking at claims filed after January 1, 2023, an employee will receive the maximum compensation if they receive weekly wages greater than $1,909.50. Employees will receive workers’ compensation pay for two-thirds of their weekly wages if their wages fall between $954.76 and $1,909.50. If the pay is between $707.22 and $954.75, then the worker will receive weekly compensation of $636.50. Anything less than $707.21 in weekly wages will receive compensation for 90% of their wages.
How Long Does Workers’ Compensation Last?
The length of worker’s compensation benefits will depend on the severity of the injury and any resulting disability. Medical benefits under workers’ compensation will be given to the employee for as long as the employee needs them. Meaning, as long as there are medical costs associated with the injury, workers’ compensation will cover those costs.
Even though medical costs are being covered, compensation for pay can stop before the medical bills are paid. Weekly pay for lost wages will depend on the status of disability—permanent vs. temporary and partial vs. total.
There are four classifications that an injury will fall into for workers’ compensation pay and the classification determines the timeline for workers’ compensation pay of lost wages.
- Temporary total disability: lost weekly wages will be covered for a maximum of 90 days
- Permanent total disability: weekly wages will be covered indefinitely
- Temporary partial disability: lost weekly wages will be covered for a maximum of 90 days
- Permanent partial disability: lost weekly wages will be covered for a maximum of 500 weeks
For permanent disabilities that leave an employee 50% or more disabled where the person cannot return to their previous work in any capacity, they can receive workers’ compensation for life/indefinitely. Previously, there was an evaluation mandated by workers’ comp insurance to be conducted after 104 weeks of benefits, but in a recent court opinion, that was ruled as unconstitutional.
What If a Workers’ Compensation Claim is Denied?
If a workers’ compensation claim is denied, the case then flows through the Pennsylvania workers’ compensation claim litigation process. Within 21 days of notice and report of injury, the insurance carrier will give a determination and issue a Notice of Workers’ Compensation Denial. This notice goes to the employee and must be filed with the bureau.
If the claim is denied, the employee then has three years from the date of the injury (not the date of the denial) to file a claim petition known as form LIBC-362 (linked above). Filing a claim petition will reopen the claim.
When a claim is reopened, a judge will be assigned to the case, dependent on where the employee resides. A notice called the Notice of Assignment will be given to any parties involved informing them of the judge and court assignment, including the case number, date, time, and place of the hearing.
At this point, likely before, it would be beneficial to hire a workers’ compensation attorney to help with the denial and hearing process.
At the hearing, both sides of the claim will present evidence and testimony to the judge regarding the injury. The hearing my be extended to multiple days in order to hear all testimony and to ensure all information has been properly presented. If there needs to be more medical evidence obtained, the judge will allow time for the parties to gather and present this information.
After the initial hearing process, the judge will then assign a mediator and set a mediation date. Mediation will occur unless the judge decides otherwise or if one or both parties state that the mediation will not help.
If the mediation does not occur or does not resolve the case, then the parties will be instructed to attend a settlement conference before the judge. Once this occurs and the judge has all the necessary information to make a decision on the case, the judge will circulate a written decision.
After the decision has been issued, either party can appeal within 20 days of that order. The appeal must be filed with the Workers’ Compensation Appeal board. From there, the court can render another decision, which can then be appealed within 30 days to the Commonwealth Court.
The final effort either party will then have, is to file another appeal within 30 days of the Commonwealth Court’s decision with the Supreme Court of Pennsylvania. Once the Supreme Court has ruled, then the decision is final.
Are Businesses in Pennsylvania Required to Have Workers’ Compensation Insurance?
Short answer, yes—all businesses in Pennsylvania are required to hold workers’ compensation insurance. They must give notice of this insurance and display injury notice forms readily available to all employees.
Though, there are certain classifications of employers who may be exempt from holding workers’ compensation insurance. This includes:
- Employers or individuals covered under other workers’ compensation acts.
- Federal employees, railroad workers, and longshoremen are typically not required to have workers’ compensation insurance because they are otherwise covered.
- Domestic workers/servants do not need to have workers’ compensation coverage.
- Any agricultural farmers/workers who work less than 30 days OR earn less than $1,200 in a year are not required to hold workers’ compensation insurance.
- Those that request an exemption due to religious beliefs or a specific status at certain corporation.
If an employer is not required to hold workers’ compensation insurance and the employer and employees are not covered through another act, then they can file a suit against their employer to recover for injuries. If an employer is required and holds workers’ compensation insurance, then an employee cannot bring a personal injury or other civil claim against the employer.
Our team of workers’ compensation lawyers at Krasno, Krasno & Onwudinjo will provide you with the information you need to make the decisions that are right for you. We want to hear about your case.
All workers’ compensation cases are handled on a contingency basis, meaning we do not get paid unless you start receiving benefits, we prevent the insurance company from stopping or altering your benefits, or you choose to settle your case.
Email or call us at (844) 243-4843 to start your initial consultation with a trusted Pennsylvania workers’ compensation attorney.