Answers to Your Questions

Below are some of the most frequently asked questions about Pennsylvania Workers' Compensation. As experts in Workers' Comp law, Casey Legal will be glad to answer any questions you may have that are not covered here. We'll also be glad to meet with you to discuss your needs and your case. Please call or e-mail us to arrange a meeting.

What is workers' compensation?
If you sustain a job injury or a work-related illness, the Pennsylvania Workers' Compensation Act (Act) provides for your medical expenses and, in the event you are unable to work, wage-loss compensation benefits until you're able to go back to work. Additionally, death benefits for work-related deaths are paid to your dependent survivors. Benefits are paid by private insurance companies (also includes third party administrators)Êor the State Workers' Insurance Fund (a state-run workers' compensation insurance carrier) or by employers themselves if they are self-insured.

Am I covered?
Nearly every Pennsylvania worker is covered by the Pennsylvania Workers' Compensation Act. Employers must provide workers' 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.

Some Pennsylvania employees are covered by other compensation laws, including: Federal civilian employees, railroad workers, longshoremen, shipyard and harbor workers. Some others who may not be covered are volunteer workers, agricultural laborers, casual employees, domestics and employees who have been granted a personal religious exemption from the Act. Certain types of executive officers of for-profit and not-for-profit corporations may elect exemption from the Act. A worker should seek further information if there is any doubt as to coverage.

What is covered?
If your work causes an injury, illness or disease, you may be entitled to workers' 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; payment of lost wages are addressed in the next question.

When are wage-loss payments made?
You must be disabled more than seven calendar days (including weekends) before workers' compensation payments 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 21 days of your absence from work. After that, you will receive a check on a regular basis.

Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or their insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, you have the right to file a Claim Petition with the bureau for a hearing if you believe you are entitled to benefits.

Offer of Employment
If, after you begin to receive benefits, your employer has evidence to prove that employment is available to you, within your medical restrictions and in your local area, you may receive an offer of employment. You have the right to either accept or decline the job offer. If you decline, the employer may then petition a workers' compensation judge to either modify orÊterminate your benefits based upon that job.

The insurer/employer must continue to pay benefits during the hearing process unless the judge orders otherwise. In open hearings, the judge will evaluate medical evidence, both from you and your insurer/employer, on the availability of the work and your ability to do it, before rendering a decision.

When Do Wage-Loss Payments Stop?
Wage-loss benefits can be stopped by an employer/insurer who has evidence that you have returned to work at wages equal to or more than your earnings level prior to the injury and after providing a timely notice of that fact. In addition, if you are receiving temporary compensation benefits during the 90 days following the report of injury, the insurance carrier/employer may notify you they are stopping benefits because they are not accepting the claim of a work-related injury.

Other reasons that benefits may be stopped include: a workers' compensation judge stopped benefits after a hearing; the employee signs either a Supplemental Agreement or an Agreement to Stop Workers' Compensation (commonly referred to as a Final Receipt); the 500-week period of partial disability status expires.

What if there is a problem?
If you think you haven't received benefits due you, contact your employer or your employer's insurance carrier. The insurance carrier is allowed 21 days from your notice to the employer of your disability to decide to accept or deny your claim or to make payments of temporary compensation for up to 90 days. Cooperative communication with your insurance carrier is recommended. If the problem is not resolved, it may be necessary for you to file a petition with the bureau.

Forms can be obtained through the PA Department of Labor and Industry Claims Information Helpline (800-482-2383). The bureau is responsible for resolving disputes by assigning petitions to workers' compensation judges who decide each case after holding hearings on the issues.

Source: PA Department of Labor & Industry

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