When you experience an illness related to your job or an injury at work, you can file a workers’ compensation claim in Pennsylvania. Most employers must have workers’ compensation insurance that covers the cost of your medical bills, lost wages, and other associated expenses, including compensation for total or partial disabilities resulting from work-related injuries.
It’s important to understand each step in the process to avoid delays or denials. Reviewing the process of filing a workers’ compensation claim, from notifying your employer to receiving benefits, can help ensure you take the right actions at the right time to protect your rights.
If you or a loved one suffered a work-related injury or illness, don’t navigate the workers’ compensation process alone. At Luxenberg Garbett Kelly & George P.C., we bring 90 years of trusted service and a deep commitment to fighting for injured workers across Pennsylvania. Our Western Pennsylvania workers’ compensation lawyers can assist in securing the compensation you need to move forward with peace of mind. Call (724) 658-8535 today to speak with a team that treats you like family and fights for you like one of our own.
Notification
Tell your employer about your injury or diagnosis as soon as possible. Pennsylvania law requires workers to report their injury to their employer within 120 days from the date of the incident or diagnosis. Once notified, the employer must report the injury to the Pennsylvania Bureau of Workers’ Compensation, which initiates the claims process. The company has a legal requirement to file a claim with their workers’ compensation provider. Depending on the extent of your injury or illness, you may qualify for benefits that include:
- Payment for lost wages if your doctor says you must temporarily or permanently discontinue your job duties
- Medical expenses, including the cost of treatments, medications, therapy, and other reasonable care
- One-time benefits for loss of a body part, serious and permanent disfigurement, or loss of hearing or sight
Delaying the process of reporting your claim can impact your ability to receive benefits.
Benefit Type | Details |
---|---|
Lost Wage Benefits | Provides payments if a doctor confirms you must temporarily or permanently stop working. |
Medical Expense Coverage | Covers costs for treatments, medications, therapy, and other necessary medical care. |
One-Time Benefits | Available for loss of a body part, permanent disfigurement, or loss of hearing or sight. |
Medical care
Your employer can post a list of six or more approved healthcare providers to see for treatment in a workers’ compensation case. This list is often referred to as a panel of physicians, and it must include at least three physicians and no more than four coordinated care organizations.
If your employer has a properly established and posted panel, you are required to seek treatment from one of these providers for the first 90 days following your initial visit. You are allowed to switch between providers on the list during this period.
In the absence of this posting, you can see the health care provider of your choice to get treatment for your injury or illness. In emergency situations, you may seek immediate care from any provider, but for ongoing treatment, you must use a panel provider if your employer has a valid list.
After your benefits begin, your employer or their insurance company can request an appointment with an Independent Medical Examiner (IME) to assess the extent of your work-related injury or illness. Employees are required to attend these examinations, and failure to do so could result in a suspension of benefits.
The state workers’ compensation program covers most Pennsylvania employees. You can file an appeal if the insurance company denies your claim after a work illness or injury.
What Are Partial vs. Total Disability Benefits in Pennsylvania?
When workers in Pennsylvania are injured on the job, understanding the difference between partial and total disability benefits is crucial for accessing appropriate workers’ compensation support. Both types of benefits are designed to provide financial assistance, but they apply under different circumstances depending on the severity of the injury and its effect on the worker’s ability to perform their duties.
Total Disability Benefits are applicable when an employee is entirely unable to work due to their injury. These benefits are designed to replace a substantial portion of the worker’s lost income. In Pennsylvania, if an employee is deemed totally disabled, they may receive about two-thirds of their average weekly wage, up to a maximum set by state law. For injuries occurring on or after January 1, 2023, the maximum weekly compensation is $1,273.00. Total disability benefits continue until the employee can return to work or reaches a state of medical improvement. After receiving total disability benefits for 104 weeks, the employer or insurer may request an impairment rating evaluation (IRE). If the worker’s impairment rating is less than 35%, their status may be changed to partial disability.
Partial Disability Benefits come into play when an injured worker can perform some level of work, but not at the capacity or earning power they had before the injury. If an employee returns to work at a lower wage, partial disability benefits makeup two-thirds of the difference between their previous and current earnings. It is important to note that the combined amount of compensation and post-injury wages should not exceed the worker’s pre-injury earnings. Partial disability benefits are capped at 500 weeks. However, if a qualified impairment-rating physician determines that the worker’s impairment is equal to or greater than 35% during this period, the worker may petition for reinstatement to total disability status.
Both benefit types are pivotal for injured workers, providing necessary financial relief during recovery periods. Understanding these distinctions can help employees and their families plan effectively for the financial impact of work-related injuries.
For guidance on the workers’ compensation process or addressing specific concerns about your claim, getting a consultation with a Western Pennsylvania workers’ compensation lawyer can be beneficial. Speaking with an experienced attorney can help clarify your options and provide the support needed to protect your rights after a workplace injury. Contact Luxenberg Garbett Kelly & George P.C. today for a free consultation.