Workers Comp FAQs

Yes. You must notify your employer within 120 days of your injury to be eligible for workers' comp benefits. However, to avoid delays or denial, you should report your injury immediately, preferably within 21 days.

Failure to report within the 120-day deadline could result in a denied claim.

A work injury is any injury or illness that arises in the course of employment, including:

• Accidents (falls, machinery injuries, burns).
• Repetitive stress injuries (carpal tunnel, back injuries).
• Occupational diseases (exposure to toxic chemicals, lung conditions).
• Mental health conditions (PTSD, work-related anxiety, or depression).

Even pre-existing conditions aggravated by job duties may qualify for workers' comp.

• Report the injury to your employer immediately (or within 120 days).
• Your employer must file a claim with their insurance carrier.
• The insurance company approves or denies the claim within 21 days.
• If denied, you can appeal the decision through the PA Workers’ Compensation Office of Adjudication.

If your workers' comp claim is denied, don’t panic—you can appeal. Here’s what to do:

• Review the denial letter – The insurance company must provide a written explanation for the denial. Common reasons include:
• Missed deadlines (failure to report injury within 120 days).
• Insufficient medical evidence.
• Employer disputes the claim, arguing the injury was not work-related.
• Claim was filed for an excluded condition (e.g., pre-existing injuries).
• Request reconsideration – Some denials are due to missing paperwork or minor errors that can be corrected and resubmitted.
• File a claim petition – If reconsideration fails, you can file a Claim Petition with the Pennsylvania Bureau of Workers' Compensation. This must be done within 3 years of the injury.
• Attend a hearing – A workers’ compensation judge (WCJ) will hear your case, review medical evidence, and determine whether benefits should be granted.
• Appeal if necessary – If the judge denies your petition, you can appeal to:
• Workers' Compensation Appeal Board
• Commonwealth Court of Pennsylvania
• Pennsylvania Supreme Court (as a last resort)

Because the appeals process is complex, having a workers' compensation attorney can significantly increase your chances of approval.

If your claim is approved, your employer’s workers' comp insurer must start paying wage-loss benefits within 21 days of being notified of the injury.

Workers' comp benefits replace about two-thirds (66.67%) of your average weekly wage, up to a state-set maximum.
For 2024, the maximum weekly benefit in Pennsylvania is $1,325 per week.

Yes, but only for the first 90 days after your injury if your employer has a list of approved doctors. If they do not provide a list, you can see any doctor you choose.

After 90 days, you may choose your physician.

Your employer’s workers' comp insurance pays all approved medical expenses related to your injury, including:

• Doctor visits
• Hospital treatment
• Surgery
• Medications
• Therapy and rehabilitation

There are no deductibles or copays for covered treatment.

Workers' comp benefits last until you recover or reach maximum medical improvement (MMI). However:

• Temporary disability benefits last up to 104 weeks before reassessment.
• Partial disability benefits can last up to 500 weeks.
• Permanent disability benefits may be lifelong.

Generally, no—workers' comp laws protect employers from lawsuits. However, you may be able to sue if:

• Your employer intentionally caused harm.
• A third party (e.g., equipment manufacturer) was responsible for your injury.

If a third party caused your injury, you may file a personal injury lawsuit and receive workers' comp.

Yes, you must report any income earned while receiving workers' comp. Failure to report wages from another job or other benefits may be considered fraud and result in penalties or loss of benefits.

For more information regarding income reporting while receiving workers' comp, visit our workers' compensations claims page, call us at (610) 275-0700 or contact us through our submission form.

It depends:

• Workers' comp and Social Security Disability (SSDI): You can receive both, but SSDI benefits may be reduced.
• Workers' comp and Unemployment: You cannot receive both simultaneously.
• Workers' comp and Private Disability Insurance: Your policy may offset benefits.

Consult an attorney to maximize your benefits legally.

Yes, but mental health claims are more challenging to prove. Pennsylvania law requires you to show that:

• Work-related stress or trauma caused your condition.
• The work environment was "abnormal" compared to typical job stress.
• A medical professional diagnosed a disabling mental condition.

Common claims include PTSD, depression, and anxiety due to workplace violence, harassment, or trauma.

Workers' compensation (workers' comp) is an insurance program that provides wage replacement and medical benefits to employees who suffer work-related injuries or illnesses. It is designed to protect workers and employers—injured employees receive benefits regardless of fault, and employers are generally protected from lawsuits.

Yes, Pennsylvania law requires most employers to carry workers' compensation insurance. Employers must provide coverage for:

• Full-time and part-time employees.
• Seasonal and temporary workers.
• Some domestic and agricultural workers.

Failure to provide coverage can result in fines, lawsuits, and criminal charges for the employer.

Workers' compensation in Pennsylvania covers:

• Medical expenses (doctor visits, surgery, rehabilitation, prescriptions).
• Lost wages (partial wage replacement for time missed from work).
• Disability benefits (if the injury leads to temporary or permanent disability).
• Specific loss benefits (amputations, vision/hearing loss, or disfigurement).
• Death benefits (for dependents of workers who die from job-related injuries).

Workers' comp does not cover pain and suffering like a personal injury lawsuit.

Workers' comp does not cover injuries that occur:

• While intoxicated or under the influence of drugs.
• Due to self-inflicted harm.
• During off-duty activities (such as lunch breaks and commuting).
• While engaging in horseplay or intentional misconduct.
• From injuries sustained outside the scope of employment.

If your employer fails to carry required workers' comp insurance, you can:

• File a claim with Pennsylvania’s Uninsured Employer Guaranty Fund (UEGF).
• Sue your employer in civil court for medical expenses and lost wages.

Employers who fail to provide coverage may face heavy penalties, fines, and criminal prosecution.