Worker’s Compensation: Benefits 101
The Upstate Pennsylvania workers’ compensation lawyers of Munley, Munley & Cartwright have years of experience in protecting the rights of employees injured or sickened on the job. At Munley, Munley & Cartwright, our goal is to provide exceptional legal services to our clients. We strive to achieve the highest standard of excellence for the protection of individual rights through teamwork and the use of our considerable resources and experience. Munley, Munley & Cartwright will help you navigate Pennsylvania’s confusing workers’ compensation system.
For workers injured or sickened on the job, workers’ compensation covers lost wages, medical expenses, and provides a death benefit to families of workers who die as a result of their injuries or illnesses. Employers purchase insurance to cover the costs, self-insure against the costs, or pay in the State Workers’ Insurance Fund.
Nearly every worker in Pennsylvania is covered by the state’s workers’ compensation laws, including:
- Full time workers.
- Part time workers.
- Seasonal workers.
Employees of not-for-profit companies and unincorporated businesses are covered, along with those who are the sole employees of a business are covered.
Exempted employees include:
- Federal workers.
- Railroad workers.
- Shipyard and harbor workers.
- Longshoremen
- Agricultural laborers.
- Casual employees.
- Domestic workers.
- Workers exempted for personal religious reasons.
- Certain executives of not-for-profit and for-profit companies may elect to exempt themselves.
Injuries, such as an equipment failure; illness, such as an illness caused by an occupational hazard; or disease caused by the workplace, are covered under Pennsylvania workers’ compensation, with the exception of injuries caused by the violation of a law, such as drug use. Injuries caused by intoxication area also exempted.
You are covered from the date you are hired. Medical losses are covered from the date of your injury, while wage-loss benefits start from the eighth day after your injury. Once you have been off work 14 days, lost-wage benefits are retroactively paid for your first seven days.
To claim your benefits, you must report your injury promptly. If you don’t, it may delay payment of your benefits. Tell your employer the date and the place of the injury and that your injury was sustained in the course of your work. Once you have missed your first day of work, your employer must notify the Bureau of Workers’ Compensation.
For occupational diseases, your disability must occur within 300 weeks of your last employment in the job in which you were exposed to a hazard. For certain lung diseases, you can claim for benefits within 10 years if you worked at least two years in Pennsylvania in a job that exposed you to asbestos, coal or silica in the 10 years before your disability.
Your employer can deny your claim. If so, you can petition the bureau for a hearing before a workers’ compensation claim.
If your employer accepts your claim, you are required to see a physician of your employer’s choice if it has posted a list of six or more. If that physician has recommended an invasive procedure, you are entitled to a second opinion, which will be paid for by your employer, and you will not be required to undergo the procedure for 90 days.
Benefits you can claim:
- Lost wages: if you are totally disabled and unable to work, or partly disabled and can only earn part of your pre-injury income, you are eligible for compensation for your lost wages.
- Medical care.
- Specific loss benefits: for example, for a lost digit or limb, paralysis, or disfigurement.
- Your family can claim death benefits.
Once you begin to receive benefits, your employer can require you to see a physician. If you refuse, your employer has the right to appeal to a workers’ compensation judge, who then may require you to see the physician, or risk losing your benefits.
Two categories of disability apply:
- Total disability: For workers with at least 50% impairment from their work injury based on American Medical Association standards. After 104 weeks under such a category, a physician can request a medical examination to verify the status.
- Partial disability: A benefit available for up to 500 weeks for workers who are able to return to work at a lower-paying job within work restrictions.
Disabilities are also classified as temporary or permanent, depending on their duration. Thus, a worker who has suffered a career-ending injury or illness that prevents him from returning to any job may have a permanent total disability. A worker with a temporary total disability is prevented from working on a temporary basis, until cleared by a doctor. A permanent partial disability is one where an employee returns to the job, but can no longer work at full physical capability, because of a work-related injury or illness.
When you become disabled because of a work-related injury or illness, you are eligible for about two-thirds of your average weekly wages, up to a weekly maximum. Your wage losses can be offset by 50% of your Social Security old-age benefits, the employer-paid portion of retirement pension, severance pay, unemployment insurance or other employee earnings.
If while on workers’ compensation benefits your employer has evidence that employment is available to you within your medical limits and in your local area, it may offer you employment. You can choose to decline that offer, at which time your employer can petition to reduce or cease your benefits. A workers’ compensation judge will assess your case in an open hearing, relying on medical evidence from both you and your employer.
Your employer can also end your benefits if it has evidence you have taken employment at a job equal to or more than your previous job.
The PA injury attorneys at Munley, Munley & Cartwright know that when you’ve been seriously injured, the last thing you want to worry about is your income. We can help you focus on getting better by ensuring your rights to workers’ compensation are protected. Call us at 1-800-381-LAW1 or contact us online to discuss your case.
