How Do I Know What My Workers’ Compensation Settlement Covers?

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What Does Workers’ Compensation Cover?

In Pennsylvania, employees who are injured on the job are eligible to collect workers’ compensation benefits, which includes medical benefits, as well as a partial wage replacement. Although Pennsylvania’s workers’ comp program is one of the most employee-friendly in the country, filing a claim is still notoriously difficult and requires employees to comply with a series of procedural rules and guidelines, so if you were injured on the job in Pennsylvania and have questions or concerns about filing your own claim, it is important to speak with an experienced workers’ compensation lawyer who can assist you.

What is Workers’ Compensation Insurance?

Workers’ compensation is an insurance program that employers in Pennsylvania are required to provide to employees who are injured at the workplace. Under workers’ compensation PA laws, qualifying employees can receive compensation for medical bills, as well as payment for lost wages, regardless of who was a fault. In exchange, employees are prohibited from filing a personal injury claim against their employers.

Who is Covered?

Pennsylvania law requires all employers in the state who have one or more employee, whether part-time or full-time, to purchase workers’ compensation insurance coverage. Employers who have been operating for more than three years may be eligible to self-insure, but most businesses choose from one of the following options:

  • Purchasing a policy through an insurance broker or agent;
  • Purchasing coverage directly from a private sector insurance carrier;
  • Joining a certified group self-insurance fund; or
  • Obtaining insurance from the State Workers’ Insurance Fund.

Regardless of who provides coverage, workers’ compensation insurance policies ensure that employees who are injured on the job and while acting within the scope of their duties are able to collect compensation to cover their losses. Unfortunately, not all employees are covered in Pennsylvania. Excluded workers include:

  • Volunteer workers;
  • Independent contractors;
  • Domestic employees, such as babysitters or housekeepers;
  • Agricultural laborers;
  • Exempt executive officers;
  • Employees who have been granted a personal religious exemption; and
  • Federal employees who are covered under separate workers’ compensation laws.

However, even employees who are technically covered by the state’s workers’ compensation laws will be barred from recovery if the injury was:

  • Intentionally self-inflicted;
  • Sustained while breaking the law;
  • The result of illegal drug use; or
  • The result of intoxication.

Employees whose actions do not fall under one of these categories will be covered by workers’ compensation insurance, as long as their injury was work-related. Work-related injuries are those that occur while an employee is working for the benefit of the employer or who becomes ill as a result of those duties. Carpal tunnel syndrome, for example, will be considered a work-related injury if an employee developed it as a result of typing on the job. Not all injuries are so clearly linked to a specific work-related duty, so if you were injured while on your lunch break or while commuting in the company car, you may face additional legal hurdles when collecting compensation and could benefit from the advice of an experienced attorney.

What Benefits Are Available?

Pennsylvania’s workers’ compensation benefits include:

  • Payments for lost wages totaling two-thirds of the employee’s average weekly wage, although the maximum amount payable for 2017 is $995 per week;
  • A specific loss award if the injured worker lost the permanent use of a body part or was disfigured as a result of an injury;
  • Payment for surgical and medical services, in addition to medicine, supplies, hospital treatment, orthopedic appliances, and prostheses; and
  • Death benefits, which will be paid to an employee’s surviving dependents.

Wage loss payments are not made until at least seven days have passed since the date of the injury. However, those who are out of work for two weeks will also receive retroactive payment for the first seven days. Generally, employees who report their injury promptly and have their claim accepted by the insurer can expect to receive their first check within three weeks of the injury, after which, they will receive a weekly check. Even when a claim has not yet been accepted, employees can receive temporary compensation for up to three months. Once this deadline has passed, or the employer has denied a claim, the injured employee can file an appeal with the Office of Adjudication.

Types Of Injuries

In most cases, these benefits are only provided until the injured employee can return to work, although the amount of time that he or she will continue to receive benefits also depends on whether the injury qualifies as:

  • A total disability;
  • A partial disability; or
  • A disability resulting from permanent injuries, such as disfigurement and the loss of a body part.

For example, employees who suffer a specific loss, such as the permanent loss of the use of a body function or limb are eligible to collect compensation based on a preset schedule. In these situations, injured workers can collect two-thirds of their pre-injury wage, multiplied by the number of weeks specifically listed on the schedule. However, after 104 weeks, the injured employees may be required to undergo a medical examination to confirm their level of disability.

Many employees are not permanently disabled, but even after returning to work after a certain amount of time, may struggle with a partial disability. If these individuals are forced to accept lower paying work as a result, they can continue to receive benefits equalling two-thirds of the difference between their pre-injury and post-injury wage. Employees suffering from this type of partial disability could be eligible for these benefits for up to 500 weeks.

Time Constraints On Claims

Only employees who comply with the state’s notice requirements will be eligible to receive compensation upon sustaining an injury at work. For example, employees are urged to notify their employers within 21 days of sustaining an injury, but are absolutely required to file a claim within at least 120 days. In the event that a claim is denied by an employer or its insurer, the injured worker has three years to file an appeal.

However, if the claim involves an occupational disease, the injured worker must be able to prove that the illness occurred within 300 weeks from the date of his or her last employment. Failing to comply with these deadlines can result in a forfeiture of a person’s rights to compensation, so if you were hurt at work and have not yet filed a claim, you should speak with an experienced workers’ compensation attorney who can ensure that your claim is not denied for a failure to adhere to all necessary deadlines and procedures.

Contact an Experienced Philadelphia Workers’ Compensation Lawyer Today

Being injured at work can leave victims not only in physical pain, but also financially overwhelmed and unsure of what to do next. This is where a workers’ compensation lawyer can step in and help ensure that injured employees are able to collect medical benefits and wage loss payments until they get back on their feet.

If you were injured at work in Pennsylvania, please contact Krasno Krasno & Onwudinjo at 800-952-9640 to learn more about the state’s workers’ compensation laws and how they apply to you. And remember, you do not owe us anything unless you win!