Understanding Workers Compensation
If you sustain a job injury or a work-related illness, the Pennsylvania Workers’ Compensation Act provides for your medical expenses and, in the event that you are unable to work, wage-loss compensation benefits until you’re able to go back to work. This can be a difficult, scary, and confusing process for anyone. Here are some insights to help you better understand workers compensation.
Q: What are some of my options if I’m injured at work?
A: There are a number of potential sources for disability or wage benefits, depending on the circumstances of the individual. Among the most common sources of disability and wage replacement benefits include:
- Short or long term disability benefits, often provided either through an employer or via an independently purchased short or long term disability insurance policy;
- Unemployment benefits, for people who have worked for the amount of time required and who have lost their jobs due to no fault of their own;
- Social Security Disability benefits, for people who have worked for the amount of time required and who are disabled and unable to work due to a condition or conditions that have lasted or are medically expected to last for more than a year;
- A lawsuit against the negligent party that caused the loss of income;
- Workers’ Compensation benefits; and/or
- Supplemental benefits through your collective bargaining unit or employer.
Q: The insurance company denied my claim. How do I get Pennsylvania Workers’ Compensation Benefits?
A: Your employer and its insurance company have 21 days from the time you notify them of a work injury to accept or deny your claim. If denied, you will need to file a petition to have your claim litigated before a Workers’ Compensation Judge.
Q: How long can I expect this workers’ compensation process take?
A: Although no case is the same, The workers’ compensation litigation process can take up to a year. So, frequently, an injured worker may apply for Unemployment Compensation, or Short Term and Long Term Disability, and in some cases Social Security Disability.
Q: How much wage replacement will I receive from workers’ compensation?
A: The general rule is that an injured worker receives 2/3 of his or her pre-tax weekly pay in workers’ compensation benefits. There are multiple exceptions. There are maximum and minimum amounts by law. Wage replacement benefits are based on two thirds of a worker’s “average weekly wage”. The 2020 maximum weekly workers’ compensation wage loss benefit was $1,081.00. That weekly compensation has been upped by $49 in 2021 to $1,130. The rate is based on the injured worker’s “Average Weekly Wage,” which is a number often in dispute.
Q: Can I collect Unemployment?
A: If the injured worker is capable of working, but not at her preinjury job, she may be eligible for unemployment. The injured worker could collect the unemployment benefits, but then the employer would be entitled to a dollar for dollar offset against any worker’s compensation benefits covering the same period.
Q: Do I get paid for my “pain and suffering,” and the interruption my work injury has on my life?
A: Unlike a personal injury action, the Pennsylvania Workers’ Compensation Act pays wage loss and medical benefits related to the work injury, but no pain and suffering, and no loss of consortium.
Q: Is it possible to sue a third party – like the manufacturer of the defective materials I worked with?
A: It is sometimes possible to pursue a personal injury lawsuit against a negligent third party while simultaneously collecting workers’ compensation benefits. It would be best to consult a Workers’ Comp Lawyer, like those here at High Swartz, to review your options.
Q: The insurance company wants me to go to a specific doctor. Do I have to go?
A: There are two categories of physicians an employer may ask you to see through the workers’ compensation system.
The first are “Panel Physicians.” If your employer posts a list of physicians designated to treat employees for work injuries, Pennsylvania law requires you to treat with a physician from the panel for the first 90 days of treatment for a work injury. There are exceptions to this rule.
The second category is IME or DME physicians. Pennsylvania law allows the insurance carrier or your employer to have you evaluated by a physician of its choosing at reasonable intervals. These evaluations, known as independent medical evaluations (IMEs) or defense medical evaluations (DMEs), are not for the purpose of treatment. Instead they are designed for the insurance carrier to get an opinion “independent” of your treating doctor regarding the status of your work injury.
There are consequences for not attending an IME.
Q: Can I settle my workers’ comp claim for a lump sum?
A: Yes. A Pennsylvania Workers’ Compensation claim may be settled, by agreement of the parties. All aspects of a claim are negotiable in a settlement. After negotiating and reaching an agreement, the parties must file a petition to present the settlement to a Workers’ Compensation Judge, in a hearing, before it can be approved and finalized. There are multiple facets of non-workers’ compensation benefits to be considered as part of any negotiation and settlement.
As a workers comp law firm, we certainly don’t expect these FAQs to give you a full understanding of workers compensation. If you are considering filing a workers’ compensation claim, or if a claim has been filed against you, don’t go it alone. Please consider contacting High Swartz’s Workers’ Comp team lead by Thomas E. Panzer at 1-833-LAW-1914 or firstname.lastname@example.org. Our workers comp lawyers at our Bucks County and Montgomery County law firm are here to assist you.
The information above is general: we recommend that you consult a workers comp lawyer regarding your specific circumstances. The content of this information is not meant to be considered as legal advice or a substitute for legal representation.