How does workers’ compensation work in Pennsylvania?

Pennsylvania requires virtually every employer to provide workers’ compensation coverage. If you’ve ever had a near-miss at work, you may have wondered how the program works. Do you have to file a lawsuit? Can you be denied coverage? How do I apply?

The workers’ comp system was created to balance the interests of workers and employers. Having injured or sick employees file lawsuits against their employers was extremely disruptive and didn’t guarantee the worker would receive the medical care and wage replacement they needed. High injury awards put companies’ survival at risk, while denied claims threatened the wellbeing of innocent people.

Now, instead of using the winner-take-all personal injury system to resolve workplace injuries and illnesses, we use the workers’ compensation insurance system. Employers are required to purchase workers’ comp insurance or, if they qualify, to self-insure. All workplace injuries and occupational illnesses are compensated through this insurance. In exchange, workers give up the right to sue their employers for damages.

Most, but not all, employees are covered

If you work an ordinary, non-federal job, chances are you’re covered by the Pennsylvania Workers’ Compensation Act. If you’re not, there is a good chance you’re covered by a similar program. Some workers who may not be eligible for Pennsylvania workers’ compensation include:

• Federal workers
• Longshoremen, shipyard and harbor workers
• Railroad workers
• Agricultural laborers
• Domestic workers
• Casual or volunteer workers

What kinds of injuries and illnesses are covered?

Physical and mental conditions are covered, as long as they occurred at work or your work activities contributed to them. Both injuries and illnesses are covered, as long as they are work-related. Your eligibility for workers’ comp starts on your date of hire.

Self-inflicted injuries are not covered. Injuries caused by the worker’s violation of the law may not be covered, which includes the use of illegal drugs. You also may not be covered if your injuries were the result of your own intoxication. And, you won’t be covered if it is determined that your injury or illness was not work-related, although you have the right to appeal.

How do I get benefits and what are the benefits?

To apply for workers’ comp, the first step is to notify your employer that you have been injured or that you suspect an occupational illness is related to your work activities. You must not delay in making this report, as failing to notify your employer could cause your claim to be delayed or even denied. Your employer will file a first report of injury once you have missed a day, shift or turn of work.

If your claim is denied at this point, you have the right to petition the Bureau of Workers’ Compensation for a hearing before a workers’ compensation judge.

If your claim is approved, you can expect to receive the following benefits, as appropriate:

• Payment of reasonable, costs for related medical care (in some circumstances, at a provider chosen by your employer)
• Partial lost-wage payments if you are partially or totally disabled from working
• Specific loss benefits if you suffered amputation, disfigurement or certain other permanent injuries
• Death benefits for your survivors

Do I have to get a lawyer to get workers’ comp?

Not necessarily, but it might be helpful. Even the initial stages of a workers’ comp claim can be confusing, and it can be useful to have someone to consult with questions. Also, a workers’ comp attorney can help ensure your claim is properly filed and contains all the necessary medical evidence. You will definitely want an attorney if your claim is denied or if you face other challenges.