Pennsylvania Workers’ Compensation Questions
If you’re hurt on the job in Pennsylvania, you probably have questions about workers’ compensation. The process can be complicated, and there are many times when you may need an attorney’s advice.
That’s why we’ve taken the most common questions people ask us and answered them for you. Our answers cover frequently asked questions (FAQ), including workers’ compensation topics such as:
- Who is responsible for providing workers’ compensation benefits?
- Are all workers covered?
- What injuries and illnesses are covered?
- Can I sue my employer or co-worker for causing my injury or illness?
- I live in Pennsylvania but work in a different state. Where do I apply for workers’ compensation payments after I’m hurt on the job?
- If I’m receiving Pennsylvania workers’ compensation payments and my employer offers me a light-duty job, do I have to take it?
- I feel like I’m being forced back to work, but I’m not ready to return. Will I lose my workers’ compensation coverage if I refuse to return to work?
- Is the workers’ compensation insurance company allowed to follow me, take photos, and talk to my neighbors?
Your employer is required by law to provide workers’ compensation coverage to their employees. Those who are self-employed may be rare exceptions to this law. While employers are required to have workers’ compensation coverage, there are still uninsured employers.
Most Pennsylvania full-time and part-time workers are covered by the Workers’ Compensation Act. Even if an employer only has one employee, that employee is covered. Generally, those who are not covered are self-employed.
The majority of all injuries and illnesses caused by a work-related accident or a condition are covered under Pennsylvania workers’ compensation.
The only injuries that may occur in the workplace and are not covered under workers’ compensation are:
- Injuries that are intentionally self-inflicted, including suicide
- Injuries that are caused by your own intoxication or illegal drug use
- Injuries that result when a co-worker attacks you for personal reasons
- Injuries that result when a person unrelated to your employer or your workplace attacks you for some reason not related to your job
- Injuries that are caused by breaking the law
No, you can’t sue your employer or co-worker for causing your injury or illness. You can only file for workers’ compensation to pay for your lost wages and medical bills. You are not paid for pain and suffering from your work injury.
There are two exceptions:
- If your injury or illness was caused by a defective product, you may have a personal injury case against the manufacturer of the product.
- If a co-worker assaults you based on a personal matter. You may be able to file a civil or criminal lawsuit against your co-worker.
Pennsylvania’s workers’ compensation payments are higher than those in many surrounding states. So, obviously, you will want to see if you can receive workers’ compensation payments in Pennsylvania.
You may be able to receive Pennsylvania workers’ compensation payments if:
- You work in Pennsylvania
- You live in Pennsylvania but work in another state
- You were hired by a company based in Pennsylvania
Each claim is different and must be evaluated on an individual basis. Unfortunately, just because you meet one of these criteria doesn’t mean you’ll be eligible for workers’ compensation in Pennsylvania. Our workers’ compensation lawyers can help you with these issues. The best way to get started is to take advantage of our free legal evaluation.
If your employer can prove that they have a job for you within your medical restrictions, such as a light-duty job, and you choose not to take it, your employer can ask a workers’ compensation judge to either modify or terminate your benefits.
If you feel that your employer is trying to force you back to work even though the company doctor doesn’t think you’re ready, chances are that your company will drop the pressure.
However, if the company doctor says you’re ready to return but your own doctor disagrees, you can refuse to return to work. Though your employer may file a “Petition to Terminate, Modify, or Suspend Benefits,” your payments won’t change until a judge reviews your case.
If your own doctor feels you’re ready to return to work, but you disagree and refuse to return to your job, be aware that there is a good chance you will lose your workers’ compensation coverage.
If one or more of these situations apply to you, it’s important that you contact a workers’ compensation attorney right away. A lawyer can help you figure out if it’s in your best interest to return to work. We can help with a no obligation, free legal evaluation.
Yes, Pennsylvania workers’ compensation insurance companies often use investigators. They are allowed to follow you, take photos, and talk to your neighbors. If you are seriously injured and are following your doctor’s orders regarding restricted activities, you should have nothing to worry about.
Under workers’ compensation laws in Pennsylvania, can I receive payments:
- For any injury or illness?
- For repetitive motion injuries such as carpal tunnel?
- If I was injured while volunteering?
- If my work injury was my own fault?
- If my job requires travel— or lacks a fixed place of work—and I was injured in a car accident while driving home from work or a work-related event?
- If I was injured on my lunch break?
- If a previous injury was aggravated on my current job?
- If I was injured at home while doing work for my employer?
You may be eligible for workers’ compensation payments in Pennsylvania if you:
- Are hurt on the job
- Aggravate a pre-existing injury
- Develop a work-related illness, such as asbestosis or carpal tunnel syndrome
You may request workers’ compensation payments, even if you are at fault for your injury at work. Accidents that occur while traveling to or from work, or during breaks, generally do not qualify for Pennsylvania workers’ compensation.
Yes. If you can prove that your injury is work-related, you could request workers’ compensation payments. Jobs that require repetitive motions to perform them can cause carpal tunnel syndrome and other disorders.
Probably not. In most situations, you must be paid in some way for your work in order to be covered.
However, some volunteers, such as firefighters, ambulance workers, and special school police, are able to collect Pennsylvania workers’ compensation payments.
Yes. Pennsylvania workers’ compensation laws allow you to request payment for work-related injuries regardless of fault. But, intentional, self-inflicted injuries are not covered under workers’ compensation.
People who have no fixed place of work — like traveling nurses and consultants — are generally covered once they take to the road and are on the clock. For example, in most cases, a traveling salesperson would be eligible to receive payments if injured in a car accident while visiting clients.
Probably not. The general rule is that any personal time taken during the work day — including lunch breaks — would not be covered under Pennsylvania workers’ compensation.
It depends on whether the aggravation is a new injury or a recurrence of the old injury. If your medical records show that you have a new injury and that it was related to your current job, you would be able to receive workers’ compensation payments.
If you chose to take work home, you would not be covered. However, if your employer specifically asked you to do work at home, you probably are covered.
- How long do I have to file a claim in Pennsylvania?
- Can my claim be denied if I don’t report the injury in time?
- Can my employer fire me for filing a Pennsylvania workers’ compensation claim?
- What forms should I sign? What forms should I not sign?
- What if my employer refuses to file an accident or incident report?
- What should I do if my workers’ compensation claim has been denied?
- Immediately report any work-related injury or illness to your employer or supervisor. In Pennsylvania, you have 120 days to let your employer know that you had a work injury.
- You have 3 years from the day you were injured to file a claim petition for an injury.
If you are hurt at work, notify your employer as soon as possible. Under the Pennsylvania Workers’ Compensation Act, if you don’t tell your employer that you were injured within 120 days, you can’t receive workers’ compensation.
No, your employer cannot fire you for filing a workers’ compensation claim. But, you may be fired for other reasons, including an extended absence from work even if it’s the result of your injury. If you are a member of a union, the union may protect your job security. But your employer may stop other benefits, such as your health insurance.
The Workers’ Compensation Bureau prints almost all forms on the same color paper, and they can be very confusing. You should make sure you read the documents very carefully. In Pennsylvania, if you sign a document, the Courts believe that you have read it and understood it, and they will enforce what you have signed, even if you made a mistake.
You should sign the following forms:
- Authorization for Medical Records: This form releases your medical records so that the insurance company can review them to process your claim.
- Employee Verification Form: You must complete this form whether or not you have earnings from alternative employment. You must return this form within 30 days of receipt or jeopardize your right to receive benefits.
Be careful if you are asked to sign the following forms. Our law firm recommends that you do not sign these until you have first consulted with an attorney:
- Supplemental Agreement: Usually this form states that you can go back to work and your claim is still open. However, this form may state that your benefits are being terminated. Do not sign this form unless you are fully recovered from your injury.
- Final Receipt: Do not sign this form unless you are fully recovered from your injury. If you are being pressured to sign and you don’t think you are completely recovered, our Pennsylvania workers’ compensation attorneys can help.
If your employer refuses to complete an injury report on your behalf, you may file a claim petition for workers’ compensation payments. You will need to go to a series of hearings with a workers’ compensation judge. While you are not required to have an attorney with you at the hearing, we highly recommend consulting an attorney. The workers’ compensation process can be very tricky, with opportunities to make mistakes at every turn.
If you were denied workers’ compensation benefits even though you know that you’re too hurt to work, you need to contact a lawyer right away.
There are many situations in which your workers’ compensation claim may be denied even though you’re still too hurt to go back to your job. If you were denied workers’ compensation benefits even though you know that you’re too hurt to work, you should contact a workers’ compensation attorney right away.
- What types of Pennsylvania workers’ compensation payments can I receive for a work injury?
- When will I receive my first workers’ compensation check?
- How much will I get paid for lost wages?
- Am I in danger of losing my workers’ compensation payments?
- How do I know if a request to end my workers’ compensation payments has been filed?
- My employer sent me a petition saying my workers’ compensation payments should stop on the day I was examined by my employer’s doctor. Will my Pennsylvania workers’ compensation payments stop?
- Should I accept a lump sum settlement?
- How will taking a light-duty job affect my workers’ compensation payments?
- How do I pay my bills while I’m waiting for my workers’ compensation payments to start?
In Pennsylvania, you may be able to receive workers’ compensation payments if a doctor places you on medical leave from work for more than 7 days. To be paid for your first 7 days of missed work, you need to be off of work and under a doctor’s care for at least 14 consecutive work days.
If your workers’ compensation claim is approved, you may be able to receive the following payments:
- Medical Benefits
- Total Disability Benefits (lost wages)
- Partial Disability Benefits (lost wages)
- Specific Loss Benefits
- Death Benefits
You should receive your first check sometime after 21 days following the date you told your employer about your injury.
In Pennsylvania, payments for lost wages are approximately 2/3 of your average weekly wage up to a pre-set maximum. In 2011, the weekly maximum is $858.
Keep in mind, wage loss benefits can be reduced if you are receiving other payments such as a pension.
You can lose your workers’ compensation payments if you:
- Refuse to submit to reasonable medical services
- Refuse to comply with an order to have a medical exam
- Are convicted of a crime and are put in jail
- Fail to complete and return an employee verification form to the workers’ compensation insurance company within 30 days
Your lost wage payments can also be stopped:
- By a judge appointed to review the facts of your workers’ compensation claim
- If you have fully recovered from your injury and have signed a “Final Receipt” – signing this receipt means you agreed to stop your benefits
- If you are assigned to a modified, or “light duty,” position; you may still be able to collect partial disability payments if the job pays less than what you made before your injury
- If you agree to receive a lump sum of money, also known as a “Compromise and Release”
- When you return to work and are making the same, or more than, you made before your injury
- The 500-week period of partial disability is over
- The time you had to collect specific loss payments ends; this time period is set based on the nature of the injury
- If you die from causes not related to your work injury
If you think you’re in danger of losing your workers’ compensation benefits and you don’t already have an attorney, you should contact one right away. We offer a no obligation, free legal evaluation.
You should receive a notice telling you that they plan to stop your workers’ compensation payments. Your employer must file a “Petition to Terminate, Modify, or Suspend Benefits.” If you receive one of these petitions, and don’t already have a lawyer, you should contact our experienced workers’ compensation attorneys.
The petition you received is called a “Petition to Terminate Compensation Benefits.” Your employer filed the petition because they believe that you have recovered from your injury and can now return to work.
A workers’ compensation judge will decide if your payments will stop. Until those hearings take place, you should still receive your workers’ compensation benefits and payments. If you’ve received one of these petitions, we highly recommend you contact an attorney if you believe you’re still too injured to work, or if your personal doctor hasn’t released you to work.
First and foremost, never accept a lump sum settlement without contacting an attorney. You may actually be losing out on the workers’ compensation benefits and payments you deserve by taking a lump sum settlement before exploring all your options.
You might be eligible to settle for a lump sum, also known as a “Compromise and Release,” if you’ve been off work for over four months due to your work injury, and you’ve been receiving workers’ compensation benefits. It’s important to remember that once you accept a lump sum settlement, you can’t request further benefits even if you still remain unable to work.
Visit our lump sum page to learn more about this type of settlement and whether it’s the right option for you.
If you return to work and you make:
- The same amount of money or more money than what you made before you were hurt, your payment for lost wages will be suspended.
- Less money than you made before you were hurt, you will receive lost wage payments in the form of partial disability benefits.
Partial disability payments equal approximately 2/3 of the difference between what you make now and what you made before you were hurt.
Example: You make $300 per week at your light duty job. Before you were injured, you made $450 per week. The difference between the two pay rates is $150 per week. Your partial disability payment would be 2/3 of $150, or approximately $100.
Your payment can not go over the maximum weekly payment rate that was set for the year you were injured. If you were injured in 2011, your weekly maximum in Pennsylvania is $858.
While you wait for a decision on your PA workers’ compensation claim, you could:
- Check to see if your employer has a disability policy or sick and accident policy as part of your work benefits package
- Use any vacation or sick time you have available
- Seek public assistance
If you do receive Pennsylvania workers’ compensation payments, your payments may be reduced based on the amount of money you are receiving from a sickness and accident policy, public assistance, unemployment compensation, Social Security disability benefits, pension, etc.
- Do I have to see a company doctor for medical treatment of a work-related injury?
- What happens to my workers’ compensation payments if the doctor releases me to light-duty work?
- What if the company doctor releases me to go back to work but my own doctor disagrees?
- What if my own doctor says I can go back to work, but I don’t think I can?
- Will I be reimbursed for travel expenses related to medical treatment for my work injury?
- If my doctor says I can’t return to my original job, does workers’ compensation have to pay to send me to school for job retraining?
If your employer posts a list of company doctors at your place of work, you must see one of these doctors during the first 90 days of treatment. If you don’t use a company doctor for the first 90 days, workers’ compensation doesn’t have to pay your medical bills.
Ninety days after seeing a company doctor for the first time, you may choose your own doctor. You need to tell the workers’ compensation insurance company who your new doctor is within 5 days to make sure that your doctor gets paid. But, your employer may request that you still see one of their company doctors once every 6 months.
You can also refuse to allow a representative of the workers’ compensation insurance company to be present during examinations with your doctor.
If your company does not have a panel of doctors posted, you may see your own doctor from the very start of your treatment.
If your doctor releases you to light-duty work but your employer does not have a light-duty job available, you can continue to receive your Pennsylvania workers’ compensation payments.
If your employer has a light-duty job available for you, the activities needed to perform the job would have to be approved by your doctor. If the light-duty job pays less than what you made before you were injured, you would be entitled to receive partial disability payments.
Even after you return to your job, workers’ compensation will continue to pay any reasonable and necessary medical expenses related to your work injury. In addition, your workers’ compensation payments may start again if:
- You are laid off
- You are fired without cause
- Your doctor takes you off work again while you are on light-duty work
If the company doctor releases you to return to work, but your personal doctor disagrees, you can refuse to go back to work.
If you do not return to work, your employer will probably file a “Petition to Terminate, Modify, or Suspend Benefits.” In this case, under workers’ compensation laws in Pennsylvania, you will continue to receive your workers’ compensation payments until a hearing is scheduled for a judge to review your case.
If you get one of these letters, and don’t already have a lawyer, you should get help from one of our experienced workers’ compensation attorneys.
If you do not have another doctor who agrees with you, you risk losing your workers’ compensation payments by refusing to return to work.
You usually receive reimbursement only for medical appointments required by your employer or their insurance company.
To receive reimbursement, be sure to:
- Keep receipts for parking and tolls
- Maintain a log of your mileage including the date and destination of each trip
You are usually not reimbursed for traveling to medical appointments that you have requested, including visits to your own personal doctor.
No, your employer is not responsible for retraining you even though you were injured at work.
Injured on the Job? Get a Free Legal Evaluation
If you were injured on the job, you may have many questions. The Pennsylvania workers’ compensation system can be very confusing, and any mistake could jeopardize your ability to receive workers’ compensation benefits. Plus, your employer’s insurance company will not look out for your own best interest.
At Edgar Snyder & Associates, we’ve helped over 7,000 injured workers get the workers’ compensation benefits they deserve. We protect your legal rights and help you choose the right options for you and your injury.
Call 1-866-9-4EDGAR (1-866-943-3427), or fill out a form at the top right of this webpage. We offer a free legal evaluation, with no strings attached. You’re not obligated to use our services, so you have nothing to lose. Phones answer 24/7. Call now.