Pennsylvania's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers.
Exemptions from coverage may apply to certain employees, including some agricultural workers and domestic employees.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including coverage for necessary medical care.
The employer may choose the initial treating physician from a list provided by the employer. If no list is provided, the employee may choose the doctor. If a list is provided the employee must treat with the selected doctor for the first ninety days of the claim, and may subsequently change doctors with proper notice to the employer.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 7 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's average pre-injury weekly wage, subject to a cap, and continue for up to 104 weeks. At 104 weeks an injured worker may be reclassified as having a permanent disability, and become eligible for additional benefits by virtue of that reclassification. Offsets may apply based upon the receipt of unemployment insurance, retirement benefits, and severance pay.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Pennsylvania an injured worker can potentially receive wage loss benefits for the duration of the disability, based upon 2/3 of the injured worker's pre-injury wage and subject to a cap.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Pennsylvania there is no PPD benefit above and beyond the 500 weeks of TPD benefits available to injured workers.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Pennsylvania, wage loss benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 500 weeks.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 60% of the worker's average weekly wage, subject to a cap in amount. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability. Spousal benefits end upon remarriage, with the spouse receiving a two year lump sum benefit.
If a deceased worker has no dependents, an additional amount is paid to the estate.
Attorney fees are limited by statute to 20% of the compensation award. Fees must be approved by a workers' compensation judge or the Workers' Compensation Appeals Board.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Pennsylvania Bureau of Workers' Compensation
Department of Labor and Industry
1171 S. Cameron Street, Rm. 324
Harrisburg, PA 17104-2501
(717) 783-5421 or 1-800-482-2383