Workers Compensation FAQs

To receive workers’ compensation benefits, you typically must receive treatment from a company-chosen doctor. However, there are exceptions to this rule.

Employers typically have a “panel of doctors” posted at your work site. If a panel is posted with six or more providers listed, you must see a doctor from that list for at least the first 90 days after your injury. You can choose any doctor on the list.

After the 90 days is over, you can see your own doctor as long as you provide notice to the workers’ compensation insurer within five days of changing physicians.

The company doctors must be qualified professionals who are licensed to practice medicine and who provide reasonably competent treatment. If your employer does not have a “panel of doctors” posted anywhere at your job site, you can choose your doctor from the start and have your bills covered.

You have the right to have your medical bills covered and to receive disability benefits if your injury causes you to miss work. However, you must notify your employer of your injury and take steps to protect your rights.

Pennsylvania employers are required by law to provide workers’ compensation insurance. Both full- and part-time workers are covered. You can make a claim for benefits after any injury or illness that is caused by your work. This includes repetitive stress conditions and illnesses such as mesothelioma or cancer caused by exposure to toxins at work.

Workers’ compensation benefits include:

• Full coverage of all medical costs
• Total or partial disability benefits (once you miss at least seven days of work)
• Specific-loss benefits, including benefits for scarring
• Death benefits.

You can make a claim for benefits even if your employer followed all safety rules and was not negligent in any way. You can even get workers’ compensation benefits if you made mistakes on the job site that caused your injury.

However, you must file notice of your work injury within 120 days of the incident. You must also file a claim petition for an injury within three years of the date of the injury. A workers’ compensation lawyer can help you to take care of the forms and paperwork.

All medical care costs should be covered by PA workers’ compensation. However, there are certain requirements for having your medical bills paid.

Medical care costs that are covered include:

• Emergency room treatment
• Surgery
• Medicine
• Medical supplies
• Hospital treatment and hospital services
• Orthopedic appliances
• Prosthetics.

Your medical costs are covered even if you do not miss work due to your illness or injury.  Health care costs are payable at the “fee scheduled rate.” The provider treating you cannot charge you any balance the insurer/employer does not pay (balance billing).

However, if you get treatment outside of the state of Pennsylvania, balance billing may occur. You may be charged extra costs.

To have your bills covered, you may need to see a doctor on your employer’s list of company physicians for the first 90 days. If your employer asks you to undergo an exam, you need to do it. You will be required to comply with all treatment recommendations or your benefits could be discontinued.

If a company doctor recommends invasive surgery, you are entitled to a second opinion.

Please see our page that discusses the importance of Accurate Medical Records in your case.

You should receive workers’ compensation benefits until you are able to return to work. However, there may be pressure to accept a settlement or to go back to work before you are ready to do so.

Medical benefits should continue until your work injury has healed and no further treatment is required. Disability benefits may continue until certain events occur.

Disability benefits will stop if:

• You have returned to work and are making wages equal to or greater than what you earned prior to getting hurt
• You refuse to submit to reasonable medical treatment/services
• You do not comply with an order to undergo a medical exam
• Your specific-loss payments end
• You are receiving partial disability benefits because you are on restricted duty, and 500 weeks has passed
• You sign a supplemental agreement or a “final receipt”
• You fail to complete an employee verification form and return it to the workers’ compensation insurer within 30 days of receiving the form
• You sign a “Compromise and Release,” which means you agree to accept a lump sum of money to settle a dispute over benefits.

If you are being pressured to sign forms or to go back to work before you are ready, talk to a lawyer to make sure you don’t jeopardize your continued benefits.

Workers are sometimes cleared only for light duty work and are assigned to modified jobs. When the new work pays less than the work you did prior to being injured, partial disability benefits are paid for up to 500 weeks.  Benefits will end if you begin to make as much, or more, than you made prior to the injury.

You should be sure you are not pressured to go back to work or to sign forms stopping benefits before you are truly recovered enough to do your job.

You may receive Social Security Disability (SSD) and Pennsylvania workers’ compensation benefits at the same time. However, your SSD benefits may be reduced or offset by your workers’ comp benefits.

Social security and workers’ compensation benefits have different qualifying requirements.  If you meet eligibility requirements for both workers’ compensation disability and SSD income, you may collect both.

However:

• The total amount of workers’ compensation, SSD benefits and other public benefits cannot exceed 80 percent of your current average earnings prior to your disability.
• If the total amount does exceed 80 percent of average current earnings, your SSD benefits are reduced by that amount.

For example, if your average current earnings were $4,000 per month before you were disabled, and you are married with two children:

• You would be eligible to receive $2,200 per month in SSD benefits.
• In PA, you would receive 2/3 of your average weekly wages up to a maximum of $917/week.   You would receive the maximum of $917/week.
• Your total combined benefits of $2,200 + $917 would equal $3,117.

In this case, 80 percent of your current average earnings are $3,200. Your combined benefits are less than this amount. So, you would not experience a reduction in SSD benefits.

However, if you were eligible to receive $2,500 per month in SSD benefits and $917 in work-injury benefits, you would have $3,417 coming in. You would exceed the $3,200 maximum you are permitted. Your SSD benefits would be reduced by $3,417-$3,200, resulting in a $217.00 reduction in benefits.

Employers cannot be sued for an on-the-job injury. However, it may be possible to recover more compensation for a work injury by filing a lawsuit against a third party.

Workers’ compensation lets you get benefits even if your employer wasn’t negligent. However, workers’ comp doesn’t provide compensation for some things that you are paid money for in a personal injury or wrongful death claim.

Although you have to show negligence or wrongdoing to get compensated in a lawsuit, you can recover much more for your losses. You may be able to collect compensation for things like pain and suffering, emotional distress or loss of companionship.

Examples of these types of “third party” claims are:

• Drivers who cause a car accident on-the-job
• Non-employer project managers
• Architects or engineers
• Subcontractors
• Manufacturers of malfunctioning workplace equipment.

A workers’ compensation lawyer can help you to find out if there are any third parties you can sue after you were hurt at work.

How can PA employers make the workplace safer?

Employers in Pennsylvania are legally obligated to protect employees and follow all state and federal safety rules. Employers can also make workplaces safer by responding when employees report hazardous conditions.

OSHA regulates everything from when guardrails are required to how workers should be protected when working in the hot summer sun. Going above-and-beyond the minimum is also helpful. Employers should guard against any potential risks and always strive to eliminate hazards.

Unfortunately, employers may not always be aware of dangerous conditions. Workers are in the best position to let their employers know if something is wrong.

Some employers discourage this kind of reporting even though they legally cannot take negative action against you for reporting safety violations. Employees who do report safety violations and experience negative consequences from their employers as a result should speak with a lawyer right away.

Can a lawyer help me with PA workplace safety issues or after a work injury?

Although the law protects your rights after a work injury, there are steps you need to take in order to obtain workers’ compensation benefits. It is essential to have an experienced PA Workers Compensation Lawyer by your side.

At Shor & Levin, we will fight for your right to receive all the funds that the law says you should receive – whether this comes from workers’ compensation or from a lawsuit.

 Can I get PA workers’ compensation benefits if I get hurt at work?

Accidents can happen even if safety rules are followed. Regardless, if your accident happens at work, you should be entitled to Pennsylvania workers’ compensation benefits.

The workers’ compensation rules in Pennsylvania provide protection to workers.  In any case where you are hurt doing something you had to do for work, you can file a claim.

For instance, if you were off your normal job site, but you were doing something your boss asked you to do, you can still pursue a workers’ compensation claim. You also don’t need to show that a safety result was violated or that your employer did anything wrong. Benefits should be available regardless of who was at fault.

Can I ever file a lawsuit if I get hurt on-the-job in Pennsylvania?

A Pennsylvania employer who provides workers’ compensation benefits is shielded from being sued by an employee for a workplace injury or illness. However, in certain situations, a personal injury or wrongful death lawsuit may be appropriate.

If someone besides your employer or a co-worker was to blame for your on-the-job injury, you have the right to file what is called a “third-party injury claim” against that party.

In contrast to a workers’ compensation claim, you will have to prove that the party did something wrong that harmed you. For instance, you would need to show that the party was unreasonably careless or sold a defective product that caused your injury.

There are very strict rules in court about how your third-party injury claim needs to be presented. You should talk to a Pennsylvania workplace injury lawyer to get help.

You can seek compensation for any pain and suffering or emotional harm your injury causes. The funds you recover in a personal injury or wrongful death lawsuit may be much greater than what you would receive in a workers’ compensation claim.

What are some of the biggest risks that I and other PA workers face on the job?

Employees in Pennsylvania often are put in danger when employers violate safety rules set by OSHA. With just one OSHA investigator assigned to every 4,300 workplaces (and one inspector for every 62,000 workers), these hazards may not be detected unless workers like yourself identify and call attention to them.

When OSHA investigates a workplace and finds that an employer is not following the rules, it issues citations. OSHA’s list of the top safety violations employers get cited for include:

• Surfaces that drop to a lower level and aren’t adequately marked
• Lack of guardrails or fall protection systems
• Chemicals or toxins in the air that workers aren’t alerted to or warned about
• Dangerous scaffolding
• Poor air quality on the jobsite and a lack of respiratory protection
• Dangerous electrical wiring
• Machines without machine guards or equipment that is otherwise unsafe
• Hazardous energy areas not secured by lockouts or tag-outs
• Wobbly or poorly constructed ladders that don’t support their load.

Since these are the top things employers do wrong, these are also the key risks that workers face on-the-job.

Workers in certain fields also face industry-specific risks. For example, nurses may be especially at risk of violent patients. Someone who works on a construction site may be in danger of being struck on the head by a falling object.

What is a “work related illness?

For a full definition under PA workers’ compensation law, click here.