TYPES OF COMPENSATIONThere are four types of compensation benefits associated with a worker’s claim. You may be eligible for all or some of these benefits:
Medical BenefitsWage Loss BenefitsSpecific Loss BenefitsDeath BenefitsPenaltiesLump Sum SettlementMedical Benefits
If you are found to have a work-related injury or disease, your employer is obligated to pay for all reasonable and necessary medical expenses associated with the injury or disease.
These benefits are paid directly to the medical provider. Under Pennsylvania law, the medical provider cannot bill you the difference between the provider’s charge and the amount allowed under the Act. However, this practice, known as "balance billing," is permitted in other states. Employees whose injuries are governed by Pennsylvania law need to be careful of balance billing when being treated by medical providers outside Pennsylvania.Back to top
Wage Loss Benefits
Your benefits are calculated by analyzing your wages for the year before the date of your injury. The average weekly wage is calculated by averaging your wages during the three highest quarters of the previous year. You are entitled to receive approximately 2/3 of your pre-injury average weekly wage, up to a statewide maximum, which increases every year. It is important to remember that:
Workers’ compensation benefits are not taxable.Low-wage employees may be entitled to receive more than 2/3 of their weekly wage. Wage-loss benefits are fixed at the date of injury with no increase to reflect inflation. A raise received after the injury will not affect your calculated average weekly wageBack to top
Specific Loss Benefits
The Pennsylvania Workers’ Compensation Act outlines "specific losses" and lists the benefits you receive if you have suffered a permanent loss of a limb, or a loss of the use of certain limbs or body functions. The law recommends the number of weeks for each specific loss plus a "healing period." You are entitled to receive benefits for the period set forth in the Act, whether or not you lose time from work for your injuries.
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Death Benefits
Death benefits may apply if an employee dies as a result of a work- related illness or injury within 300 weeks of the date of illness or injury:
The amount of the benefit will depend on the number of dependants. Widows or widowers who remarry are entitled to a lump sum equal to 2 years of wage-loss benefits. Orphaned children, parents, brothers, and sisters may be entitled to compensation benefits if they were dependent or partially dependent upon the employee at the time of death. Burial expenses not to exceed $3,000 are also available.Back to top
Penalties
Pennsylvania workers’ compensation law permits injured workers to receive significant penalties over any wages or medical bill payments if the insurance companies are guilty of excessive delays in paying the benefits. The workers’ compensation judge has the authority to impose penalties of up to 50% for late or illegally suspended benefits.
- Attorney’s fees may be recovered under certain circumstances.
- The amount of the penalty is left to the discretion of the workers’ compensation judge and will depend on many factors, including any excuse or explanation the employer or insurance company has for the delay.
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Lump Sum Settlement
Under Pennsylvania law, workers may settle with employers and insurance companies to receive a lump sum payment in exchange for giving up the right to any other workers’ compensation benefits, including payment for ongoing medical treatment.
This option should be considered carefully: this is especially true where the worker has been advised to have expensive or long-term medical treatment, such as surgery. Future medical care may be denied coverage by the health insurer if it should have been covered by workers’ compensation when the claim was originally made.
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FENNER & BOLES: Protecting Pennsylvania’s Employees for More Than 25 Years.
