FAQs

You Do Have Rights Under the Worker's Compensation Act!

The Pennsylvania Workers' Compensation Act was enacted in 1915. The Act has been amended on multiple occasions since that time. Most recently the Act has been amended in 1993, 1995, 1996 and 2006. Each time the Act was amended, the rights and the liabilities of both the injured worker and the employer changed.

This Act defines the liability of the employer to pay damages for injuries sustained by an employee in the course and scope of employment. Simply put, the Act gives the rules which an employer must follow when an employee is injured on the job. The following are some of the most commonly asked questions regarding the Pennsylvania Workers' Compensation Act:

The general rule is that if you are an employee who is injured in Pennsylvania, you are covered by the Pennsylvania Workers' Compensation Act. You may also be covered if you are injured outside of PA in certain situations, such as if your employment is usually located in PA.

No. Some categories of workers are not covered exclusively by the PA Workers' Compensation Act. These workers, such as federal employees, military personnel, maritime workers and railroad workers, are covered by alternative legislation, such as the Federal Employees' Compensation Act, Jones Act, Longshoremen's and Harbor Workers' Compensation Act or the Federal Employers' Liability Act. In some cases, the injured worker could be covered by more than one Act.

Other categories of employees, such as casual employees, home workers, domestic service workers, agricultural workers, real estate salespersons and brokers, and insurance agents may also be excluded from coverage under the PA Workers' Compensation Act. Finally, independent contractors, since they are not "employees," may not fall under the PA Workers' Compensation Act. Whether or not an injured employee is covered by the PA Workers' Compensation Act often depends on the specific facts of each case, and should be reviewed by an attorney experienced with interpreting the PA Workers' Compensation Act.

The general rule is no. You cannot sue your employer because you were hurt doing your job. The PA Workers' Compensation Act is what is called an "exclusive remedy." This is your only avenue to recover for your injuries from your employer. There are very narrow exceptions to this rule, but they rarely apply.

You can, however, sue your employer for actions or conduct other than causing your injury. For example, you can sue your employer for discriminating against you because of the work-related disability, or for terminating you because you filed a workers' compensation claim.

Also, you can sue someone other than your employer for causing your injury. For instance, you can sue the manufacturer of a machine whose defect caused the injury, or the other driver who negligently caused the motor vehicle accident.

The PA Workers' Compensation Act provides two main benefits. You have the right to be compensated for wage loss and medical treatment.

The Act generally pays two-thirds of your pre-injury wages, up to a maximum that varies by the year you were injured. This pre-injury wage would include as many jobs as you held at the time of the injury. Employers frequently make mistakes in calculating the pre-injury wage, and these figures should be carefully checked.

If you return to work after your injury, but at reduced wages due to the injury (for instance, working only part-time), the PA Workers' Compensation Act directs payment of two-thirds of the wages you are losing.

The Act also requires payment for "reasonable and necessary" medical treatment which is related to your work injury. This treatment can include office visits to your physician, rehabilitation and/or physical therapy, prescriptions, surgery, chiropractic treatment, diagnostic tests and whatever other medical treatment is reasonable and necessary for your work injury.

The Act does not provide for pain and suffering.

As noted above, the Pennsylvania Workers' Compensation Act provides for both Total Disability, when you are not working at all, and Partial Disability, when you are working with a loss in wages due to the injury.

There is no specific limit to the time you can receive Total Disability benefits. However, after you have been disabled for 104 weeks, the workers' compensation insurance carrier can request an "Impairment Rating Evaluation (IRE)." If this rating results in you being less than 50% impaired, for the whole body, then your disability status may change from Total to Partial. While this change does not affect the amount of benefits you receive, it will change the time you can receive them.

Once you are receiving Partial Disability benefits, either because you returned to work at a loss in wages, or an IRE found you less than 50% impaired, you may be limited to 500 weeks of these benefits. This is another factor that you should discuss with an attorney experienced in workers compensation.

Not necessarily. If you were injured after 1996, and your employer has properly posted a Panel List of Health Care Providers, you must treat with a facility on that Panel for the first 90 days after your injury if you want the workers' compensation insurance carrier to pay for your treatment. Please note, however, that the employer has many rules in regard to creating this Panel List, as well as notifying the employee of this list. If the Employer does not comply with these rules, you may not be limited to the doctors on the panel.

When the 90 day period after the date of injury expires, you may treat with the medical provider of your choice. You should, at that time, select physicians you are comfortable with. You not only can choose your main treating physician, you can also select your own specialist, second opinion, and physical therapy or rehabilitation facility.

Also, be aware that the employer/insurance carrier may request that you go to a specific doctor for an examination. This would not be for treatment. The employer/carrier may or may not be entitled to have you examined, depending on the situation and frequency of the request.

No. Under the PA Workers' Compensation Act, the Employer/Insurance Carrier is not required to provide any vocational services to an injured worker, including retraining. While many times the Employer/Carrier will pay a vocational counselor to work with you to find employment, the vocational counselor is working at the request of the Employer/Carrier, and may have a primary motivation of limiting your Workers' Compensation benefits, rather than finding employment that is truly suitable for you.

The Act only requires the Employer/Carrier pay workers' compensation wage loss benefits until they have a basis to stop the payments, such as by proving either you are fully recovered or there is employment available to you within your physical restrictions. If the Employer/Carrier assigns a vocational counselor to work with you, you should immediately consult with an attorney to learn of the specific rights and obligations in your case.

Yes. You may settle your workers' compensation case for a lump sum. However, you should be very careful in deciding whether to settle your case. YOU ARE GIVING UP RIGHTS IF YOU SETTLE YOUR CASE. Injured workers should consult with an attorney to discuss their rights and specifics of their case prior to agreeing to settle. Once you settle your case, you most likely will NOT be able to change your mind.

Never sign any papers without reading the entire paper (both sides) and consulting with an attorney. Be aware that there are documents under the PA Workers' Compensation Act which can cost you rights EVEN IF YOU DO NOT SIGN THEM. Some documents must be immediately appealed to protect your rights. Do not forget the employer/carrier has an attorney, who knows the PA Workers' Compensation Act. You should have an attorney who also knows the Act. Remember, the employer/carrier does not have the same goals as you in regard to your case. They want to save money and get you back to work. You want to get the best possible medical treatment and get better.

Most workers' compensation attorneys will charge you by "contingency" fee, meaning that the attorney will not charge anything unless he or she is able to either get you workers' compensation benefits, or protect you from having your benefits stopped by the Employer/Insurance Carrier. If the attorney is successful, the fee will generally be a percentage of your workers' compensation check. It should never cost you any money out of your pocket. Be sure to discuss the fee arrangements with any attorney you consult. Further, confirm who will be paying for the cost of litigation. Most people who have been injured at work do not have extra money to put out for litigation costs.

This information is courtesy of BRILLIANT & NEIMAN LLC.

This material has been prepared by Brilliant & Neiman LLC for informational purposes only and should not be construed as legal advice or legal opinion on any specific facts or circumstances. These materials do not, and are not, intended to constitute legal advice.

The information provided here is subject to change without notice. Although we try to keep our materials current and accurate, you should not rely on this information or its applicability to any specific circumstances without speaking with an attorney. Information provided here is consistent only with basic principles of Pennsylvania law and no other jurisdiction.

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