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All employers in Pennsylvania are required either to carry Workers’ Compensation insurance that they purchase through an insurance company or self-fund. Employees are covered under the insurance on their first day on the job.
Workers’ Compensation insurance provides a source of income and medical benefits to compensate employees who are injured, contract an occupational illness, or experience worsening of an existing ailment due to conditions at their place of employment.
Workers’ Compensation benefits are available regardless of the employee’s previous medical or physical condition and without regard to the employee’s fault. If you suffer from a work-related injury or illness, Workers’ Compensation will cover reasonable and necessary medical expenses.
Be aware that if you file a Workers’ Compensation claim, you may be asked to undergo an examination with a doctor other than your primary physician. This is called an independent medical evaluation (IME) and provides an expert opinion about any disputes in your case.
Most often, the insurer will request an IME and select the examining physician, when it disagrees with a treating doctor about whether:
- The injury or illness is related to work.
- Suggested treatment, such as surgery, is necessary.
- The return-to-work date is appropriate.
- There is a permanent disability that precludes a return to work in any capacity.
You may have to undergo several IMEs while receiving Workers’ Compensation benefits.
What Are the Different Types of Workers’ Compensation Benefits?
There are various benefits an employee can expect to receive from Workers’ Compensation depending on the nature and extent of their illness or injury.
Workers’ Compensation pays for total, partial, temporary, and permanent disabilities as follows.
Total Disability Benefits
Approximately two-thirds of the workers’ salary for total disability up to a maximum dollar amount provided by law is paid for the time lost from work if the disability lasts longer than seven calendar days.
If you are unable to work due to your injuries, you will be eligible for temporary total disability benefits. There is no time limitation for receiving temporary total disability benefits. However, after receiving temporary total disability benefits for 104 weeks, the insurer may require you to undergo an Impairment Rating Evaluation (IRE). After that exam, the insurance company will consider you partially disabled if you have less than 35 percent whole-body impairment. This does not change the amount of benefits that you receive, but will limit the duration of your benefits to 500 weeks.
Partial Disability Benefits
Partial disability benefits begin if you return to work earning less per week than your time-of-injury job. If your new position pays less than the job you were doing when you were injured, you will receive two-thirds of the pay difference based on the average weekly wage up to the maximum pay rate the year you were injured.
Your employer or the workers’ compensation insurance carrier may attempt to reduce your benefits to partial disability based on a Labor Market Survey. A Labor Market Survey is a method to determine your “earning capacity” based on your ability to perform work based on your age, work restrictions, education and prior work experience.
Partial disability payments are payable for 500 weeks.
Specific Loss Benefits
If your injury resulted in the loss of a body part, loss of hearing or vision, or if you suffered severe or permanent disfigurement to your neck, head, or face, you will be eligible for specific loss benefits. This benefit equals your total disability benefit and runs for a specific time.
Medical Expenses
Any medical expenses incurred as the result of your injury are covered, including:
- Hospital treatment, services, and supplies. Workers’ Compensation provides semi-private rooms or private room accommodations if no semi-private rooms are available.
- Orthopedic appliances and supplies.
- Prescription medicines and supplies.
- Reasonable surgical and medical services needed.
- Services provided by doctors or other health care providers.
The coverage also includes modifications needed to your vehicle to accommodate the injury. There are no time or other restrictions on payment for medical care for your injury.
Travel Expenses
If your treatment appointments take you out of the area where you work or live, you may qualify for travel expense reimbursement as part of your compensation. The insurer must also provide transportation to and from the location of your IME if you cannot get there on your own.
Death Benefits
If you die after a work injury, your heirs will be eligible for death benefits from your Workers’ Compensation coverage. Benefits are paid to your spouse until they remarry and your children under 18 years old unless they are enrolled full-time in an accredited school, in which case they will receive payment until they are 23 years old. Benefits include reimbursement of $7,000 in funeral expenses for deaths occurring after October 24, 2018 (If the death occurred prior to October 24, 2018, reimbursement will be $3,000).
What Does Workers’ Compensation Not Cover?
Workers’ Compensation insurance does not pay for your total loss of wages, pain and suffering, loss of enjoyment of life’s pleasures, or the loss of dignity and confidence a seriously-injured worker can suffer. It also does not provide job security or guarantee that certain contract benefits in a collective bargaining agreement will continue.
Note that injuries that happen during your commute to and from work, such as a car accident, are not covered. Injuries sustained while you are on personal time, and performing activities unrelated to your job during the workday are also not covered.
What Is a Workers’ Compensation-Covered Injury?
Any injury directly related to and sustained while performing your job will generally be covered under Workers’ Compensation.
Your employer or the property owner or manager of your work location is responsible for safety and providing personal protective equipment. Still, accidents happen. Sometimes, a defective work tool, vehicle, or other device is also to blame.
Common safety hazards can cause burns, electrocution, broken limbs, internal bleeding and organ damage, traumatic brain injury, and more. Common industries with a high number of Workers’ Compensation claims include:
- Aircraft pilots and flight engineers
- Construction workers
- First responders
- Hazardous materials handlers
- Heavy machinery operators
- Iron and steelworkers
- Logging workers
- Manufacturing workers
- Refuse and recyclable materials collectors
- Roofers
- Truck drivers
It is important to note that not all injuries are outwardly apparent. Workers can suffer illnesses caused by exposure to toxins and carcinogens in the workplace resulting in lung disease, heart disease, cancer, neurological disorders, or systemic poisoning.
The effects of health hazards may be slow, difficult to diagnose, and complicated by other factors. For example, exposure to a cancer-causing chemical can take many years to cause a tumor or death. You will need the help of a lawyer and others to establish a link between the workplace and your illness if you want to pursue Workers’ Compensation benefits or a legal claim.
You are eligible to collect Workers’ Compensation if your job contributed to or worsened an existing condition. For example, if you have a bad back and lifting materials off pallets at work worsened your condition, you are eligible to collect benefits.Philadelphia Workers’ Compensation Lawyers at Galfand Berger LLP Help Injured Workers Get Benefits
If you have been injured at work, one of our Philadelphia Workers’ Compensation lawyers at Galfand Berger LLP can help. Our dedicated legal team will protect your rights and ensure that you receive what you are entitled to under the law. Call us at 800-222-USWA (8792) or contact us online to schedule a free consultation. Located in Philadelphia, Bethlehem, Lancaster, and Reading, Pennsylvania, we serve clients throughout Pennsylvania and New Jersey, including Allentown and Harrisburg.