|Philadelphia, Pennsylvania Worker's compensation|
Benefits in Pennsylvania
What is worker’s compensation?
If you are unable to work because of a job injury or a work-related illness, Pennsylvania’s Workers’ Compensation Act (the “Act”) provides for your medical expenses and wage-loss compensation benefits until you are able to go back to work.
Benefits are paid by private insurance companies or the State Workers’ Insurance Fund (a state-run worker’s compensation insurance carrier) or by employers themselves if they are self-insured.
Are you covered?
Nearly every Pennsylvania worker is covered by the Pennsylvania Workers’ Compensation Act. Employers must provide worker’s compensation coverage for all of their employees, including seasonal and part-time workers. Non-profit corporations, unincorporated businesses, and even employers with only one employee, must comply with the Act’s requirements.
What is covered?
If your work causes an injury, illness or disease, you may be entitled to compensation. No compensation shall be paid when an injury or death is intentionally self-inflicted, or is caused by an employee’s violation of the law including, but not limited to, the illegal use of drugs. An injury or death caused by intoxication also may not be covered.
When am I covered?
Coverage begins on the date of hire. Medical benefits are payable from the first day of injury.
How do I get the benefits?
Prompt reporting is the key. Report any injury or work-related illness to your employer or supervisor immediately. You must tell your employer or supervisor that you were injured in the course of employment and inform your employer of the date, place and time of the injury. Write down the names of anyone who sees the injury occur. Failure to notify the employer can result in the delay or denial of benefits. Once you have lost a day, shift or turn of work, your employer is required to report your injury to the Bureau of Workers’ Compensation by filing an Employer’s Report of Occupational Injury or Disease.
What are the benefits?
The law provides several types of workers’ compensation benefits:
Payments For Lost Wages Wage-loss benefits are available if it is determined that you are totally disabled and unable to work or partially disabled and receiving wages less than your pre-injury earnings. In other words, you are only entitled to payments for lost-wages when your work-injury prevents you from working or causes you to make less money because you cannot perform your pre-injury job.
Death Benefits If the injury results in death, surviving dependents may be entitled to benefits.
Specific Loss Benefits If you have lost the permanent use of all or part of your thumb, finger, hand, arm, leg, foot toe, sight, hearing, or have a serious disfigurement on your head, face or neck you may be entitled to a specific loss award.
Medical Care In the event of a work-related illness or injury, you are entitled, if covered under the Act, to the payment of surgical and medical services rendered by a physician or other health care provider if the services are reasonable, necessary and related to the work-injury. The employer is responsible for the payment of medical bills related to the work injury even if the employee does not miss any time from work due to the work injury. Under the Act, the employee may not be charged the difference between the health care provider’s charge and the amount paid by the employer or it’s insurance carrier. In other words, there can be no “balance billing” to you.
Choice of Doctor
If you employer has posted a list of six or more physicians or health care providers in your workplace, then you are required to visit one of them for initial treatment. You are to continue treatment with that provider or another on the list for a period of 90 days following the first visit. It is the employer’s legal obligation to post this list.
If during the 90-day period you visit other providers, your employer or your employer’s insurance carrier may refuse to pay for such treatment. After that time period, as well as in situations where your employer has no posted list or an improper list, you may seek treatment with any physician or other health care provider you select.
How much are the payments for lost wages?
Wage-loss benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum.
When are wage-loss payments made?
You must be disabled more than seven calendar days (including weekends) before worker’s compensation benefits for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.
If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 121 days of your absence from work. After that, you will receive a check regularly as you received your wages prior to the injury
When do I need lawyer?
You need a lawyer if the employer does not live up to it’s obligations under the Act. You may represent yourself in Court against the employer and it’s insurance company but be warned that workers’ compensation law is complex and your employer will certainly have an experienced attorney working on their behalf. If you have any questions, your questions will be answered free by an experienced attorney at (215) 557-9855.
ROBERT P. BRAND, ESQUIRE