Practice Area: Workers' Compensation

When you run a business in Pennsylvania, you must fulfill several legal obligations to protect your company and employees. One of the essential requirements is carrying workers' compensation insurance. But is it mandatory for every business in the state?

We'll clarify Pennsylvania workers' compensation rules, highlight common mistakes business owners make, and explain why compliance is crucial.

If you have additional questions about workers' compensation, talk to a workers comp lawyer at our local law firm. We support business owners and employees throughout Bucks, Delaware, and Montgomery County, PA.

You can learn more about employer rights and duties under the state's workers' compensation program.

What is Workers Compensation Insurance?

Workers' compensation insurance benefits cover employee work injuries or illnesses relating to their job. It covers medical expenses, lost wages, and even rehabilitation costs. The purpose of this insurance is twofold:

1. Protect Employees: It ensures injured employees receive the necessary support if they suffer a workplace injury or illness. Equally important, it prevents employees from suing their employer for medical care and disability benefits.
2. Protect Employers: It shields businesses from costly lawsuits by providing a no-fault system. Employees receive benefits regardless of who is at fault.

Workers' compensation laws require coverage across the United States. However, each state has its own rules and regulations.

Is Workers' Compensation Mandatory in Pennsylvania?

Yes, workers' compensation is generally mandatory for most employers in Pennsylvania. You must carry workers' compensation insurance if you have one or more employees. That applies to both full-time and part-time employees.

Who Needs to Have Workers' Compensation Insurance?

In Pennsylvania, the law requires almost all employers to carry workers' compensation insurance, including:

• Businesses with Employees: Any company that employs one or more individuals must have coverage. That applies even if employees work part-time or seasonally.
• Non-Profit Organizations: Non-profits are not exempt. If they have employees, they need coverage just like for-profit companies.
• Agricultural Employers: You must have coverage if you pay wages of $1,200 or more during a calendar year and an employee works 30 or more hours per week.
• Domestic Employees: You need workers' compensation if you hire domestic workers, such as nannies or caregivers. That applies if the worker works 40 hours weekly for a single employer.

Are There Any Exceptions?

Pennsylvania laws permit some exceptions:

• Sole Proprietors and Partners: Sole proprietors and partners in a business don't require workers' comp. However, they must cover any employees.
• Family Members: Immediate family members working in agriculture or some small, family-run businesses may be exempt. However, consulting a workers' compensation lawyer is recommended to ensure compliance with the specific exemptions and coverage requirements.
• Independent Contractors: Workers' comp generally excludes independent contractors. However, misclassification can lead to significant penalties.

Understanding these requirements is vital for failing to have the proper coverage can lead to severe consequences.

Penalties for Non-Compliance

Failing to carry workers' compensation insurance in Pennsylvania is a serious offense. If you operate without the required coverage, you could face the following penalties:

• Criminal Charges: Non-compliance can lead to criminal charges and fines. Penalties apply per violation, and cumulative fines can far exceed $15,000 in cases of multiple offenses. In some cases, employers may face imprisonment.
• Civil Penalties: Injured workers can sue employers lacking coverage. As an employer, you're potentially liable for all compensation, medical expenses, and damages.
• Business Closure: The state can issue a stop-work order. So, it can shut down your business operations until you obtain the required coverage.
• Reputational Damage: Non-compliant employers can hurt their reputations. It can affect your ability to attract and retain talent.

Non-compliance costs far outweigh the expense of carrying workers' compensation insurance. It's not about avoiding penalties. It's about protecting your business and your employees.

Frequently Asked Questions (FAQs) About Workers Comp Insurance

Do I need workers' compensation insurance if I'm the only employee?

If you are a sole proprietor or partner, you needn't carry workers' comp insurance for yourself. However, as soon as you hire any employee, even part-time, you must have coverage.

What happens if I classify an employee as an independent contractor incorrectly?

Misclassifying an employee as an independent contractor to avoid paying for workers' compensation is a severe violation. If discovered, you could face fines and penalties and be responsible for any back benefits owed to the worker.

How much does workers' compensation insurance cost in Pennsylvania?

Workers' compensation insurance costs vary based on factors like your industry, payroll, and claim history. High-risk industries such as construction or manufacturing typically have higher premiums. Consult with an insurance provider to get a precise quote for your business.

Are there any exemptions for small businesses in Pennsylvania?

As mentioned, sole proprietors and partners without employees don't require workers' compensation benefits. Agricultural workers must meet specific conditions for exemption, such as working less than 30 hours a week for a single employer. Domestic servants must also meet particular conditions. Federal government workers, railroad workers, and dockers have different coverage.

What should I do if I receive a workers' compensation claim from an employee?

If an employee files a workers' compensation injury claim, immediately report it to your insurance company. You must also complete and submit a First Report of Injury form to the Pennsylvania Bureau of Workers' Compensation. Ensure you cooperate with your insurer and keep detailed records of the incident.

Can I be fined for not having workers' compensation insurance?

Yes. You can face significant fines, criminal charges, and even suspension of business operations suspended until you become compliant.

Experienced Workers' Comp Lawyers Near You

Workers' compensation is a crucial component of running a business in Pennsylvania. Non-compliance can lead to severe penalties, but you can navigate these laws confidently with the proper guidance.

Contact our workers' comp lawyers if you have questions about workers' compensation or need help resolving a dispute. We have law offices in Bucks, Delaware, and Montgomery County. We provide the support you need to keep your business running smoothly.

Doylestown Law Office: 215.345.8888

Norristown Law Office: 610.275.0700

Wayne Law Office: 610.975.4468

 

Workers' compensation is a required component of employment law in Pennsylvania. It provides financial and medical benefits to employees who suffer work-related injuries or illnesses, protecting employees and employers.

Understanding workers' compensation is a legal obligation. Equally important, it's essential to maintaining a safe and compliant workplace for Pennsylvania businesses. No matter the size of your company, it can help you protect your employees and your organization.

If you own a small business, find a workers' comp lawyer who can offer appropriate guidance.

Overview of Workers' Compensation in Pennsylvania

Workers' compensation is a no-fault insurance program mandated by Pennsylvania, meaning that employees are entitled to benefits regardless of who caused the injury.

It provides wage replacement, medical treatment, and other benefits to employees injured or ill. It also ensures that employees receive prompt medical attention and financial support while recovering.

The Pennsylvania Workers' Compensation Act, established in 1915, regulates and requires workers' compensation insurance. It mandates that nearly all employers, regardless of size, carry it to cover their employees.

It applies to nearly all employers, regardless of size, including private businesses, nonprofit organizations, and even some municipalities. Employers must cover all employees, including full-time, part-time, and seasonal workers.

In 2022, the Pennsylvania Department of Labor & Industry reported over 80,000 work-related injuries, and employers paid out more than $2 billion in workers' compensation benefits. These numbers highlight the significance of this program for both employees and employers and emphasize the need for businesses to understand their obligations under the law.

Failing to comply with workers' compensation requirements can result in severe penalties, including fines and potential criminal charges. Additionally, employers could face civil lawsuits from injured employees if proper coverage is not in place.

What Does Workers' Compensation Cover?

Workers' compensation supports employees who experience work-related injuries or illnesses by covering medical expenses, wage loss benefits, and specific loss benefits.

These benefits are calculated based on the nature and extent of the injury and the employee's average weekly wage.

Here's what it typically covers in Pennsylvania:

Medical Expenses

Workers' compensation covers all reasonable medical care and expenses related to the job injury or illness, including:

• Doctor Visits: Consultations with healthcare professionals.
• Hospitalization: Costs of hospital stays, if necessary.
• Surgeries: Any required surgeries from the work-related injury.
• Rehabilitation: Physical therapy and other rehabilitation services to help the employee recover.
• Prescriptions: Necessary medication to treat the injury.

These medical bills and expenses must relate directly to workplace accidents or illnesses. Employers should ensure that employees receive the necessary care to recover fully.

Lost Wages

Workers' compensation provides wage replacement benefits if an employee cannot work because of the injury. In Pennsylvania, wage loss benefits typically amount to approximately two-thirds of the employee's average weekly wage, up to a maximum amount.

Pennsylvania has different types of wage loss benefits:

• Temporary Total Disability (TTD): When the employee cannot work at all for a temporary period.
• Temporary Partial Disability (TPD): When the employee can work at a reduced capacity, leading to lower earnings.
• Permanent Disability Benefits: Employees who suffer a permanent impairment that prevents them from returning to their previous job.

Specific Loss Benefits

This benefit applies to employees who lose certain body parts, such as fingers, limbs, vision, or hearing. The amount and duration of compensation vary based on the severity of the loss (refer to the Pennsylvania Workers' Compensation Act).

Death Benefits

If an employee dies from a work-related injury or illness, their dependents can receive death benefits. Dependents include family members like a spouse or children. These benefits include coverage for burial expenses and ongoing financial support to help the family during a difficult time.

What Workers' Compensation Does Not Cover

While workers' comp provides broad coverage, there are certain situations where benefits do not apply:

Non-Work-Related Injuries

Workers' compensation only covers injuries or illnesses directly related to the employee's job. For example, the employee wouldn't be eligible for benefits if an injury occurred while playing sports outside of work.

Intentional or Self-Inflicted Injuries

Workers' compensation does not cover self-inflicted or intentional injuries by the employee. However, in cases where an injury results from intentional employer misconduct or hazardous conditions, there may be grounds for additional legal action.

Drug or Alcohol-Related Incidents

If an employee is injured while under the influence of drugs or alcohol, workers' compensation may deny the claim. The burden of proof lies with the employer or insurer to show that substance abuse caused the injury. Employers can conduct drug tests to determine if the injury stemmed from substance abuse.

Violation of Company Policies

Insurance companies can deny a workers' comp claim if the injury occurred while the employee was willfully violating a company safety rule or acting recklessly. However, coverage may still apply in cases of minor rule violations.

Understanding these exclusions can help employers educate their workforce and reduce the likelihood of disputes over claims.

If you're an employer, you can challenge a claim based on any of these concerns. An experienced workers' compensation lawyer can provide guidance. Defending a worker's compensation case can prevent you from focusing on your business, especially as a small business owner.

Employer Responsibilities Under Pennsylvania Workers' Compensation Law

Employers in Pennsylvania have specific responsibilities regarding workers' compensation. Understanding these obligations is crucial to avoiding legal issues.

Insurance Requirements

All employers in Pennsylvania must carry workers' compensation insurance. That applies to most businesses, regardless of size, including those with part-time or seasonal employees. Employers can obtain this through a private insurance carrier or the State Workers' Insurance Fund.

Employers can self-insure only after receiving the Pennsylvania Bureau of Workers' Compensation approval.

Failing to carry workers' compensation insurance can result in severe penalties, including fines, criminal charges, and potential business closure.

Reporting Requirements for Workers' Compensation

The employer must report a job-related injury to their workers' compensation insurance provider and file a report with the Pennsylvania Bureau of Workers' Compensation within 21 days of notification of the injury. However, prompt reporting is essential to avoid penalties and ensure the employee receives timely benefits.

Employers should also keep accurate records of the injury. They can include witness statements, medical reports, and any communication with the employee. This documentation is crucial in case of disputes or investigations.

Safety Programs

Employers are encouraged to implement workplace safety programs to reduce the risk of injuries. Effective safety programs not only protect employees but can also lower insurance premiums and improve the overall workplace environment. Regular safety training and clear communication of safety procedures are critical components of a successful program.

Exclusions to Workers Compensation in Pennsylvania

Although most businesses must carry workers' compensation insurance, some companies are exempt. For example, different compensation laws cover federal government workers, railroad workers, and dockers.

Other exclusions include:

• Agricultural workers may be exempt if they work for fewer than 30 days in a calendar year and earn less than $1,200 from a single employer.
• Laws exclude domestic servants unless the employer includes them under workers' comp.
• Sole proprietors and general partners are typically not required to have workers' comp coverage for themselves.
• Individuals with religious beliefs may be exempt from workers' comp. They must file the appropriate paperwork with the Commonwealth.

Talk with a workman's comp lawyer to determine if you can get by without carrying workers comp insurance.

Consequences of Non-Compliance for Employers

Failing to comply with workers' compensation laws can seriously affect Pennsylvania employers. Understanding these consequences is essential to avoid legal and financial risks.

Legal Penalties

Employers who do not carry the required workers' compensation insurance can face substantial fines and penalties. Penalties start at $2,500 and can include up to one year of imprisonment for each day of non-compliance.

The Commonwealth can sometimes shut down operations until the employer obtains proper coverage.

Civil Liability

If an employee is injured and their employer doesn't have workers' compensation, the employee can sue the employer. The employer could be responsible for paying all medical expenses, lost wages, and additional damages awarded by the court. These costs can be devastating, especially for small businesses.

Does an Employer Have to Hold a Job While an Employee is on Workers' Compensation?

One common concern among employers is whether they must hold an employee's job while on workers' compensation. In Pennsylvania, employers have no legal obligation to keep an injured worker's job open while receiving workers' compensation benefits.

However, employees who qualify for leave under the Family and Medical Leave Act (FMLA) may be entitled to up to 12 weeks of job-protected leave.

There are other essential considerations to keep in mind:

No Legal Requirement to Hold the Job

Pennsylvania law does not require employers to hold an injured worker's job open while receiving workers' compensation benefits. If necessary, an employer can fill the position to maintain business operations.

Protection from Retaliation

Employers don't have to keep the job open. However, they cannot fire or retaliate against an employee solely because they filed a workers' comp claim. Retaliation, such as wrongful termination or demotion, can lead to legal consequences, including discrimination or wrongful discharge lawsuits.

Considerations for Employers

Employers should consider several factors when deciding whether to hold an employee's job, such as the length of the employee's recovery and the impact on business operations. They should also have clear policies regarding job retention during workers' compensation leave.

Employers might also offer a modified or light-duty position. This approach can help the employee return to work while meeting the business's needs.

Best Practices for Workers' Compensation and Employers

To effectively manage workers' compensation and maintain compliance, Pennsylvania employers should follow these best practices:

Maintaining Compliance

• Audits: Regularly audits your workers' compensation coverage and workplace safety practices to ensure ongoing compliance and identify potential risks.
• Keep Coverage Up-to-Date: Verify that your insurance coverage is active and sufficient to meet your business needs. Update your policy if your workforce size or business operations change.

Creating a Safe Work Environment

• Implement Safety Programs: Develop and enforce safety programs tailored to your workplace, including training on proper equipment use, safety protocols, and emergency procedures.
• Encourage Reporting of Hazards: Build a workplace where employees feel safe to report hazards or unsafe conditions. They should not fear retaliation.

Employee Education

• Inform Employees About Their Rights: Hold regular training sessions to educate employees about their rights under workers' compensation laws and communicate the steps to take if they experience a work-related injury.
• Communicate the Claims Process: Ensure employees know the steps to take if injured, including reporting the injury, seeking medical treatment, and understanding how wage replacement benefits work.

By adopting these best practices, employers can create a safer work environment, reduce the likelihood of workplace injuries, and more effectively manage workers' compensation claims.

Experienced Workers Compensation Attorneys Near You

Workers' comp is a crucial element of employment law that every Pennsylvania business needs to understand. Employers can protect their workers and companies by understanding what workers' compensation covers. They should follow legal requirements and use best practices.

If you have questions or need legal guidance on workers' compensation, the team at High Swartz is here to help. Our experienced worker's comp attorneys can provide the advice and support you need to navigate these complex regulations confidently. We work with businesses in Bucks, Delaware, and Montgomery County, and all across Pennsylvania.

Contact us today to ensure your business is compliant and your workforce is protected.

With limited exceptions, Pennsylvania requires employers to carry workers’ compensation insurance.

Employees will be happy to know that workers' comp coverage applies to those throughout their employment. But what if your employer doesn’t have workers’ comp?

First, your employer faces some harsh penalties. It’s considered a criminal offense where the employer faces fines up to $2,500 or a year in prison for each day the employer fails to provide coverage. Each day is considered a separate offense.

Second, suppose a court finds the lack of compliance intentional. In that case, the employer may face felony charges with fines up to $15,000 and seven years of imprisonment for each day they’ve intentionally violated the requirement.

So legally, it’s in a company’s best interest to carry workers comp. But what if your employer doesn’t have workers’ compensation and you’re injured? Other than talking with a work injury lawyer near you, where's that left you?

What Are Your Options with Employers Lacking Workers Comp Coverage?

The good news is that you do have options even if your employer doesn’t have workers’ compensation.

Option 1: Uninsured Employers Guaranty Fund (UEGF)

Many states have a fund to protect workers injured while working for an uninsured employer. Pennsylvania has the UEGF that allows you to file a claim. A workers’ compensation judge oversees your case, and the UEGF assigns a lawyer to defend your claim.

If your employer is uninsured, the UEGF holds them primarily liable, with the UEGF secondarily liable. Your employer then has 30 days to pay the money you’re owed.

Your employer is most likely not going to pay. So, the UEGF makes the payment you would have received from your employer for damages like medical bills, disability benefits, and lost wages.

Now, this approach has some downsides. And unlike the typical workers’ comp claim where you might consider hiring a workers comp attorney, with a UEGF filing, you’ll want a workers comp lawyer representing you.

First, the UEGF has limited financial resources because it’s state-funded. As a result, it could take months to receive payment.

Second, unlike an insurance company that can be penalized for failing to pay within a prescribed timeframe, the UEGF has no obligation.

And finally, the UEGF doesn’t have to pay annual interest on back benefits vs. an insurance company that does. So you’re beginning to see why a work injury lawyer makes sense.

By the way, you must file a claim within 45 days from the date you discover your employer is uninsured. Otherwise, your employer’s obligations cease.

Option 2: Personal Injury Lawsuit

If you decide against filing a UEGF claim, your next best option is to hire a personal injury lawyer and sue the employer. Even though injured employees typically can’t sue their employer for work-related injuries, most states, Pennsylvania included, make exceptions when employers don’t carry workers’ compensation.
One advantage to electing this option is seeking the total amount of your losses. Many states, for example, only pay two-thirds of a worker’s wage loss. Plus, you’ll receive no reimbursement for pain and suffering.

And that’s the other advantage to a suit; you can seek damages for pain and suffering, not to mention punitive damages. Pain and suffering cover not only the injury but also emotional distress. On the other hand, punitive damages reflect damages stemming from the employer’s misconduct. Neither of these damages can be collected through a workers’ compensation claim.

Although you can potentially collect more through a personal injury lawsuit, this approach has its downside. For starters, your case needs to go through the legal process. Unfortunately, that can lead to significant delays in getting payment, months or even years.

Plus, even if you win the personal injury suit, there’s no guarantee you’ll get paid. After all, if your employer fails to carry workers’ comp insurance, what’s to say they’ll pay compensation stemming from your lawsuit?

And yes, there’s the chance you could lose your lawsuit. Unlike workers’ compensation, a no-fault system, you’ll need to prove your employer was a fault for your injury. So, if you elect to take this route, it’s best to immediately talk with a work injury lawyer to start the process and ensure you take the proper steps to file a personal injury lawsuit.

Injured and Your Employer Doesn’t Have Workers’ Compensation?

Give us a call. Our workers’ comp lawyers will work with you to determine your best option for getting reimbursed for your injury. We also have personal injury lawyers on hand to support a potential lawsuit.
High Swartz is a long-standing law firm serving Bucks and Montgomery Counties clients. We offer various legal services to support you with almost any concern.

The impacts of COVID are undeniable. Chief among them has been the proliferation of a WFH (Work From Home) workforce. Gallup reported that 43% of employees work from home at least some time. Businesses and employees have had to adapt to that new reality. One of the questions that arises is whether or not workers' comp benefits apply for WFH.

The short answer is yes. Workers’ compensation benefits may apply for injuries sustained by employees while working from home. Employees are covered for injuries regardless of location, outside or inside the employer’s workplace. The primary consideration is whether the injuries are, in fact, work-related. That said, whether the injury is truly work-related is a more complex question. It comes down to the details.

It’s clear that if an employee slips while moving a box on the employer’s premises while performing work, the corresponding injury is work-related and subject to workers’ compensation benefits. But what if that same action occurs while the employee is working from home? The answer depends on how and why the accident happened.

• Did the injury occur while the employee was doing something on the employer’s behalf? Compare a fall while walking down the stairs to perform a personal household function, versus a fall while walking down the stairs carrying work files to the employee’s at home desk.
• Was the employee required to conduct the activity by the employer? I.e., does the activity resulting in the injury further the interests of the employer.
• Was the action approved by the employer even though it happened off-site? I.e. did the employee take work home on a voluntary basis, or has the employee been authorized or directed to work from home, either part time or full time.

The burden of proof is on the employee. But, if an employee is able to explain how the injury was work-related, they may very well be given the benefit of the doubt. According to courts, it’s irrelevant whether or not the employer has control over the home-based work environment.

Commonwealth of Pennsylvania Rulings

Pennsylvania addressed the issue of workers’ comp for WFH employees during a 2006 case, Verizon Pennsylvania v. Workers’ Compensation Appeal Board (Alston). An employee was working from home and fell down her stairs injuring her neck.

The injury happened when the employee left her basement office to get a drink. When returning to answer the phone, she fell. She filed a claim alleging she was injured furthering her employer’s business interests. The Commonwealth Court ruled in her favor.

The ruling was determined based on two factors:

1. The home office was approved “secondary work premise.” Essentially, the employee’s home was an extension of the employer’s premises.
2. The timing of the injury fell under the “personal comfort doctrine”. The employee was authorized to work from home by her employer and was working prior to leaving her office to get the drink. The Court focused on the their determination that the employee sustained an “injury arising in the course of his employment.”

With regard to “off premises” work injuries, the Commonwealth Court has consistently determined that minor deviations from work, like getting a drink, does not remove an employee from the “course and scope of employment” and therefore an employee may still qualify for benefits. This concept has come to be referred to as the “personal comfort doctrine.” Employees are entitled to deviate from work for personal comfort like going to the bathroom or getting lunch to perform work more effectively.

Addressing Workers’ Compensation Risks for WFH Employees

Generally speaking, courts error in favor of employees regarding distribution of workers’ compensation benefits. The premise is that the Courts are to interpret the facts of a given case in the context of the humanitarian nature of the workers’ compensation law.

By law, employers are responsible for providing a safe work environment regardless of whether an employee is on premises or telecommuting.

A business owner, may take steps to reduce liability for a workers’ compensation claim.

1. Establish policies relating to WFH employees. Create a written policy that governs employees obligations for working from home.
2. Define work hours. WFH workers may fail to take appropriate breaks leading to fatigue. As a result, injuries may occur, including carpal tunnel, neck pain, back pain, and posture issues. Musculoskeletal disorders annually exceed $50 billion in workers’ comp claims according to OSHA.
3. Establish home office guidelines. Make sure employees understand and agree to WFH guidelines. They should have an appropriate workstation setup to prevent repetitive stress injuries.
4. Examine home office setups. By reviewing home office setups, you can eliminate potential work hazards that might lead to an accident.

Filing a Workers’ Comp Claim

Pennsylvania employers are required to carry workers’ compensation insurance. The system of workers’ compensation is considered a no-fault system . If an employee is granted WFH privileges, their home is their workplace and injuries occurring there may result in workers’ comp benefits.

Should an injury occur at home, both the employer and the employee should follow the same protocol as if the injury occurred on the employer’s premises. The first step an employee should take is to report the workers’ compensation claim. Work from home injuries may be viewed with some initial skepticism by the employer and the workers’ compensation carrier, so WFH workers need to pay particular attention to the details surrounding the circumstances that lead to the injury, and making sure they accurately communicate that information to their employer.

The first step for the employer and it’s worker’s compensation carrier is a thorough investigation. Naturally, an immediate on premises investigation may not be possible, but a thorough telephonic fact finding is a necessity. Remember, these claims are highly fact specific.

Talk to a Workers’ Comp Lawyer

If you have any questions or are looking at a workers’ compensation claim, it pays to talk with a lawyer near you. Our local law offices are located in Doylestown and Norristown and now Cherry Hill. We’ve helped countless clients with workers’ compensation claims.

Our law firm offers comprehensive legal services ranging from workers compensation to business law, litigation, and employment law.

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:

1. Short or long term disability benefits, often provided either through an employer or via an independently purchased short or long term disability insurance policy;
2. 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;
3. 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;
4. A lawsuit against the negligent party that caused the loss of income;
5. Workers’ Compensation benefits; and/or
6. 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 tpanzer@highswartz.com. 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.

If you contract COVID-19 at work, you may have a compensable Pennsylvania workers’ comp (WC) claim. However, it might not be the easiest route to financial relief.

This blog touches on the process, proofs, and pecuniary benefits of pursuing a workers comp claim.

First Things First

If you believe you’ve contracted COVID-19 at work, the first step in pursuing a workers comp claim is to notify your employer of that belief. Failure to timely notify your employer could result in the claim being permanently extinguished. After notifying your employer, the workers comp carrier will be contacted, and will need to investigate the claim and make a decision to accept, deny, or provisionally accept (accepted, but still needs to be verified) the claim, within 21 days. After this is done, it's might be prudent to consult with a workers comp lawyer near you.

Providing Proof for a Workers Comp Claim

This is where the proofs come in. Under the WC injury provisions, an injured worker needs to establish that the COVID-19 virus was contracted at work, or while the worker was in the course and scope of their employment, even off of the employer’s premises. A travelling employee may have a much more broad “course and scope” than a stationary employee. The employee also needs to establish that the exposure was “related” to the employment.

With COVID-19 being essentially everywhere, proving that the exposure was work related may be challenging. On the other hand, health care workers and emergency services personnel may have an easier time making their case because of obvious exposures. In addition, under the occupational disease standard of the Workers’ Compensation Act, the employee needs only to initially show that the presence of COVID-19 is more prevalent in that occupation. In either event, medical support for your claim is necessary.

If the COVID-19 claim is denied, the process leads to litigation which starts with filing a workers compensation claim with the Bureau of Workers’ Compensation. An injured worker is usually best served to involve knowledgeable injury lawyer to assist them through this process.

Workers Comp Benefits for a COVID-19 Claim

All of this begs the question, what does the injured worker get for the effort of going through this process? With modifications to new and enhanced wage replacement benefits due to the unprecedented COVID-19 pandemic, someone who suffers wage loss due to COVID-19 may be in for a long and complicated battle.

The primary benefits of workers’ comp are wage loss benefits resulting from the illness and medical bills related to the illness. There are certain limitations though. Wage loss benefits are typically two-thirds of an employee’s average weekly wage. There are exceptions. There is also a waiting period.

If the employee loses no more than seven (7) days, no wage loss benefits are payable. On the eighth (8th) day wage loss is payable. If the employee simultaneously receives unemployment compensation (UC), the employer gets a dollar for dollar credit for the UC paid. Please see the High Swartz blog, Can I Collect Unemployment Compensation During the Coronavirus Pandemic?

Regarding medical care, the employee must treat with the posted panel of physicians for the first ninety (90) days of treatment or the bills may not be paid. In the extreme case, workers comp does pay a death benefit to dependents.

FFCR Coverage for COVID-19

Employees should also be aware that effective April 2, 2020, an additional, or alternative, Federal benefit is available for paid leave related to the Coronavirus. The Families First Coronavirus Response Act provides for a wage loss benefit caused by the Coronavirus whether contracted at work or not. Coverage under the FFCR is more broad than the WC Act, but the benefit cap is lower than workers compensation. In any event, receipt of both benefits will undoubtedly be coordinated with credits for one against the other. Please see the High Swartz blog, How the Families First Coronavirus Response Act Will Affect Local Business

Talk with a Workers Comp Lawyer

In summary, lost time wage replacement and payment for related medical care resulting from COVID-19 illness may be covered by workers comp, but subject to the above process and proofs. Benefits will be coordinated with other employer sponsored plans to allow for recovery but not double-recovery.

The benefit landscape directly related to COVID-19 and Coronavirus is changing daily. The new Federal, State, and Employer sponsored benefits may eliminate or mitigate the need to file a workers comp claim. On the other hand, for long term wage loss or death claims, where dependent benefits are at stake, a workers comp claim may be necessary.

If you have any questions or concerns, talk with a workers comp lawyer near you or here at High Swartz in our Doylestown law office. Our law firm provides legal services to clients in Bucks and Montgomery Counties.