Pennsylvania Workers’ Compensation Laws

Nowadays, accidents can unexpectedly happen in work settings and result in fatal or non-fatal injuries. In 2021, the U.S. recorded 5,190 fatal occupational injuries, an 8.9% increase from the previous year. Pennsylvania, in particular, contributed 162 cases to the total count; slips and falls, roadway incidents, and harmful substance exposure were noted as the leading causes. According to the same report, the private transportation and warehousing sectors had the most fatalities.

Fortunately, accidents stemming from negligence or poor working conditions are preventable through the proper monitoring and implementation of health and safety standards. Now, in spite of these measures, employees may still suffer an injury or a disease at work. As such, they may be entitled to receive workers' compensation benefits.

With that in mind, this article aims to help readers dealing with occupational injuries or conditions understand the state's corresponding laws. Moreover, it lists various online resources that can assist in filing a workers’ comp claim or lawsuit.

Pennsylvania Workers’ Compensation Insurance Requirements

Did you know that workers' compensation insurance is required for all Pennsylvania businesses with one or more employees, whether new or tenured? This policy applies to full-time, part-time, and seasonal workers.

Essentially, state law may benefit both employees and employers. This is because it enables the former to obtain recompense for a workplace-related injury or illness while protecting the latter from any direct lawsuit.

Ways Pennsylvania Businesses Can Obtain Workers' Compensation Insurance

Employers in Pennsylvania have several options for acquiring workers' compensation insurance for their staff members. These include:

• Working with an insurance agent or broker.

• Partnering with a private-sector insurance carrier with workers' comp policies.

• Applying for self-insurance status through the Bureau of Workers' Compensation. (This can be a good option for large, financially healthy companies that have been in business for three or more years. Eligible companies can also join a certified group self-insurance fund.)

• Securing insurance from the State Workers' Insurance Fund, a state agency that offers coverage to all employers, especially businesses having difficulty obtaining a policy from private-sector insurance companies.

Penalties for Workers' Comp Non-compliance in Pennsylvania

Companies that fail to comply with the state's workers' comp laws may face misdemeanor or felony convictions. Penalties for misdemeanors include a maximum fine of $2,500 and a jail sentence of one year for each day that they do not have coverage in place. For felony charges, employers may face a $15,000 fine and seven years of imprisonment for every day that they lack coverage.

At the same time, staff members who have sustained an injury or illness while fulfilling their work duties may file a lawsuit against their company if it does not have the required coverage. The Department of Labor and Industry may make the employer shoulder the insurance premium from the Uninsured Employers Guaranty Fund, including any interest and penalty fees under Section 440 of the Workers' Compensation Act.

Exceptions to Pennsylvania’s Workers’ Comp Requirements

The only time Pennsylvania employers are exempted from the state's workers' compensation requirements is if all of their staff fit one or more of the following criteria:

• Agricultural workers earning less than $1,200 annually.

• Domestic laborers.

• Casual workers.

• Federal workers.

• Dockworkers.

• Railroad workers.

• Sole proprietors and LLC partners.

• Executive officers granted exemption.

• Employers granted exemptions on religious grounds.

• Real estate salespeople or brokers working under 100% commission.

Pennsylvania Workers’ Compensation Benefits

Under state law, employees should be qualified for workers' compensation starting on their first day. The different benefits will be discussed below. However, note that some injuries are not compensable. These include those suffered from activities not related to work or those sustained after recklessly conducting an on-the-job activity.

In addition, employees who receive benefits under the state’s workers' comp laws are not allowed to file personal injury claims against their employer. They can, however, pursue personal injury lawsuits against third parties that caused or contributed to their injuries. These entities may include motorists, building or construction site owners, and defective product manufacturers.

Medical Care Costs

The medical coverage of a company's workers' comp policy pays for the hospital expenses of an injured or sick employee. These costs include:

• Healthcare services: Doctor's visits, diagnostic tests, and other medical procedures.

• Hospital treatment: Room and board, surgery, and other inpatient care.

• Medicine and supplies: All prescription medications needed, as well as things like bandages and crutches.

• Orthopedic appliances: Braces, casts, and other similar devices.

Lost Earnings

Employees who have been absent due to a work-related injury, disease, or disability are entitled to compensation for their lost wages. According to state guidelines, if an employee is unable to work due to a total disability for more than a week, they will receive a tax-free benefit equal to about two-thirds of their average weekly salary.

Workers are entitled to this benefit as long as they are unable to return to work due to their condition. However, it will end once they:

• Return to full pre-injury employment.

• Recover medically with no restrictions.

• Recover partially but are able to perform other tasks available to them with no loss in wages.

The table below discusses the difference between total and partial disability status.

Specific Loss Benefits

An employee may be eligible for specific loss benefits if they have lost the permanent use of a body part or have suffered a permanent disfigurement on their face, head, or neck. Note that specific loss benefits are paid to injured workers regardless of their ability to work. 

Death Benefits

If an employee dies from a work-related injury or disease, their surviving dependents may receive death benefits, which will be based on their average weekly salary. The surviving spouse will be entitled to 51% of the decedent's weekly income, with the amount set to increase if there are dependent children. If the worker was single before death, their dependent parents and siblings could receive benefits. In addition, their family should receive $3,000 in funeral expenses.

How to File a Workers’ Compensation Claim in Pennsylvania

It is essential for both employers and employees to understand their rights and responsibilities in the workers' compensation claims process. By working together, they can ensure that injured workers receive the benefits they need to recover and return to work. 

When Is the Deadline for Workers’ Compensation Claims in Pennsylvania?

An employee who has suffered a workplace injury must act fast to obtain the compensation they deserve from their employer. The table below shows some crucial deadlines:

In Pennsylvania, the statute of limitations for workers' compensation claims is three years from the date of injury. The injured worker may lose their chance of receiving the benefits they are entitled to if they do not file a claim before the deadline.

A Step-by-Step Guide to Filing a Workers’ Compensation Claim in Pennsylvania

If an employee has been injured due to a workplace accident or has fallen ill because of poor working conditions, they should file a workers' comp claim to obtain financial assistance. This section outlines the state’s workers' compensation claims process.

Workers' Compensation Claim without Litigation

1. Medical treatment of employee: An employee injured at work must immediately go to an accredited health facility or professional recommended by their employer to get medical treatment. This step is important, as it will enable them to secure medical records that can be used to support their workers' compensation claim.

2. Notification of employer: When an employee suffers a workplace injury, they need to notify their employer within 21 days. If they fail to file a claim within 120 days from the date of the injury, they may not receive compensation. 

3. First report of injury: Once the employer becomes aware of their employee's workplace injury or illness, they should inform their insurance provider. They must also complete and electronically submit a First Report of Injury to the Bureau of Workers' Compensation. 

4. Action of employer or insurer: The company or its workers' compensation insurance carrier may issue one of the following within 21 days from the employee's notification of injury:

• Notice of Workers' Compensation Denial.

• Notice of Temporary Compensation Payable.

• Notice of Compensation Payable.

• Agreement for Compensation.  

Firstly, when an employer issues a Notice of Workers' Compensation Denial, they are refuting liability and closing the claim. However, the employee has the option to pursue recompense through litigation with the help of a workers' comp lawyer. 

Secondly, when an employer issues a Notice of Temporary Compensation Payable, it means they are requesting the Bureau to grant a 90-day extension to the investigation period before admitting or denying complete responsibility for the injury. In the meantime, the employee will receive temporary payment for their hospital expenses and lost earnings. If the employer decides to stop paying the employee temporary compensation, it must complete a Notice Stopping Temporary Compensation.

Lastly, when an employer issues a Notice of Compensation Payable or Agreement for Compensation, it means they are accepting full liability for the injury. These documents must be submitted to the BWC along with the Statement of Wages, which is used to calculate the injured employee's salary. The employee should also receive a copy of the statement. 

1. Filing of a notice of suspension or modification by insurer: The company's insurance carrier may file a Notice of Suspension or Modification within a week when the injured employee returns to work. 

2. Provision of the supplemental agreement for compensation to worker: When the insurer intends to modify the worker's benefits, they must send the employee a Supplemental Agreement for Compensation.

3. Provision of the final statement of account for compensation paid to worker: Once the final payment of compensation has been made, the insurance company must provide the employee with a final statement of account. The document should also be submitted to the BWC.

4. Agreement to stop weekly workers' compensation payments: When the insurer terminates the worker's benefits, a Final Receipt must be filed with the BWC. A copy of the document must be sent to the employee. If the worker plans to file a petition challenging the termination of payments, they have a three-year timeframe to do so.

Workers' Compensation Claim with Litigation

This section is for injured employees whose workers' compensation claims have been denied. Note that the following proceedings come after the first three steps listed in the previous section:

1. Denial of payment: When the employer does not admit liability for the employee's injury, they must issue a Notice of Workers’ Compensation Denial.

2. Claim petition: Once the injured employee receives a notice of denial, they have three years to file a Claim Petition to fight for the compensation they deserve.

3. Case assigned to a workers’ compensation judge: Following the petition, a judge will be assigned to handle the case. A Notice of Assignment will be provided to both parties.

4. Hearing scheduled: Both the injured employee and their employer will be informed of the date, time, and place of the hearing.

5. Hearing held: Both parties will provide evidence supporting their arguments regarding the claimant's workers' compensation claim. The hearing may be extended if the judge requires additional evidence or testimony.

6. Alternative dispute resolution session held: The judge handling the case may schedule mediation, if necessary.

7. Decision issued: The judge will release a ruling based on the evidence provided and the testimonies made.

8. Appeals made to the Workers’ Compensation Appeal Board, Commonwealth Court, and Pennsylvania Supreme Court: Either party may file an appeal to the pertinent court to challenge the judge's decision on the claim. The deadlines for filing an appeal can be reviewed in the table above.

What Should One Do If a Workers’ Compensation Claim in Pennsylvania Has Been Denied?

If an injured employee's compensation claim is denied, either by their employer or its insurance provider, they can file a petition with the state's workers' compensation bureau. As discussed above, a judge will then decide whether to approve or deny the appeal after multiple hearings. Before their verdict, the judge may request the testimony of the doctor who has assessed the injured employee. The appeals process can be complex, so it is wise to seek the counsel of a lawyer experienced in the field.

Legal Resources for Injured Workers in Pennsylvania

Overall, recovering from a workplace injury or illness while navigating the legal system can be challenging and stressful for an employee, especially if they lack finances. As such, this section provides helpful resources for those who are thinking about or have already started the process of filing a workers' compensation claim. These include everything from free legal help to a way to report workplace hazards.

Pennsylvania Bar Association Pro Bono Program

The state's bar association runs a pro bono program that helps underprivileged citizens deal with legal issues, including workers' compensation. Individuals who intend to request free legal aid from the program may complete its request form online. They can also access the County Pro Bono Map to learn more about volunteer lawyer activities in their area.

Legal Services Corporation

This nonprofit organization, founded in 1974, advocates for equal access to justice. It strives to fulfill its mission of supporting legal aid programs across the country through grants that will be used to assist low-income citizens. Victims of workplace accidents seeking help from legal aid organizations may visit the LSC website to learn more about Pennsylvania-based grantees. 

Pennsylvania's Department of Labor & Industry

The DLI provides pertinent information about the state's workers' compensation services and related programs. Victims of workplace accidents or hazardous working conditions filing for a claim may access the required forms and other useful resources on the DLI's official website.

Occupational Safety and Health Administration

OSHA implements safety standards for employers across the country. Workers may file a health and safety complaint if their employer isn't complying with OSHA guidelines or if there are serious workplace hazards that have not been addressed. State residents may contact the OSHA office near them if they require further assistance.