Popular Questions about PA Workers' Compensation

by Abigail Gross on Feb. 09, 2018

Employment Workers' Compensation 

Summary: During an initial office consultation, I give clients the opportunity to ask me any and all questions that they may have about their workers’ compensation case. Most clients have similar concerns, so it should come as no surprise that they ask many of the same questions. For this reason, I have compiled the most frequent questions my clients ask…and the answers I give them.

Q: What am I entitled to receive on workers’ comp?
A: Workers’ compensation provides financial assistance for those who have been injured “in the course and scope of employment.”  In most cases, you are entitled to lost wages (if you are unable to work because of your injury) and the insurance company must pay for all medical bills related to your injury.  However, in some cases, you may be entitled to other benefits, such as:

Partial Disability Benefits – You don’t have to be out of work completed to be entitled to lost wage benefits. If your injury has caused a reduction of income, you may be entitled to a partial benefit to make up for that loss.
Specific Loss Benefits – These benefits are available if you suffer an amputation or the “loss of use” of a specific body part.
Disfigurement Benefits– You may be entitled to additional compensation if your injury has resulted in disfigurement/scarring. However, these benefits are limited to those who have scars in the head/neck region.
Death Benefits – If an injury proves fatal, your spouse and/or children may be to an ongoing weekly benefit.

Q: When does workers’ comp coverage begin?
A: The minute you start working.  You are covered from day one. 

Q: How long do I have to file a claim? Is there a deadline?
A: If you are hurt, you have 120 days to give notice of the injury to your employer. Practically speaking, you should be giving notice immediately after the injury. The longer you wait, the more reason the employer/insurance company may question the validity of your claim. Assuming gave proper notice, you have three (3) years to file an actual claim.
 
Q: How long can I collect benefits?
A: You can collect lost wage benefits for as long as your injury renders you disabled. However, the insurance company will undoubtedly take action to limit that duration.
Medical coverage, on the other hand, can potentially continue until the day you die – even if you never miss a day of work. The insurance company will remain liable for the payment of all medical bills related to your injury until they can prove that you have fully recovered from your injury.
 
Q: How much do I get paid on workers’ comp?
A: The amount you collect on workers’ comp depends upon the amount that you earned prior to your injury. For some people, it is 90% of their wages, whereas it may only be 66 2/3% for others. There is also a maximum amount, which the Department of Labor and Industry adjusts each year. In 2016 it was $978.00 per week, and this year it is $995.00 per week. Though you will receive less income while on workers’ comp, there is a silver lining. Workers’ comp benefits are not taxable. When you receive a check, that money is yours free and clear.
 
Q: Do I have to treat with “their” doctors?
A: Assuming that your claim has been accepted, you are required to treat with the physicians listed on your employer’s “panel” list for the first ninety (90) days. That list should be given to you immediately after you report the injury. However, if your claim was denied or you were not asked to sign a panel acknowledgment, you are free to treat anywhere.

Q: My claim has been denied.  Will the insurance company reconsider?
A: No.  Once your claim has been denied by the insurance company, there is no such thing as a “reconsideration.” If you receive a Notice of Denial, you should immediately contact a lawyer to decide if your claim is worth pursuing.

Q: I reported the injury right away and my medical records prove that I have an injury. How can they deny my claim?
A: The insurance company can choose to deny your claim for almost any reason – but that does not mean that they have good reason. In some cases, the denial may even be in violation of the law. Again, if you receive a Notice of Denial, you should immediately contact a workers’ compensation attorney to discuss your rights.

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