Every year over two million people are injured in a work-related accident. For nearly five thousand people, workplace accidents are fatal.
Who’s covered
In Pennsylvania, almost all employees injured while working are covered by the State’ 
s Workers’ Compensation Law. The only exceptions are certain specific professions that are covered under other programs, such as railroad workers and government employees. Independent contractors, freelancers, or consultants do not qualify for workers’ compensation.
Purpose of workers’ compensation
Workers’ compensation laws are designed to provide benefits to injured workers without them having to resort to lengthy and expensive litigation with an uncertain outcome. (In Pennsylvania, under workers’ compensation, employees cannot normally sue an employer or co-workers for negligence in causing an injury. There are, however, exceptions.)
No-fault system
Workers’ compensation is based on a no-fault system. Even if your own carelessness caused your injury, you should be covered. However, you would typically not be eligible under the following circumstances:
- you intentionally injured yourself
- you were under the influence of drugs or alcohol
- you were injured in a fight or horseplay at work
Course and scope of employment
Workers’ compensation applies to injuries that occurred during the “course and scope” of one’s employment. Determining whether an employee is in the course and scope of employment usually revolves around the concept of whether the employee was furthering the employer’s business or affairs. Generally speaking, workers’ compensation doesn’t cover an employee going to or coming home from work. (There are exceptions, e.g., an employee such as a traveling salesperson not having a fixed place of work.) It is important to note that the employee’s injury need not occur on employer’s premises.
Medical coverage
Under Pennsylvania Workers’ Compensation, medical coverage includes:
- services rendered by physicians or other health care providers, including chiropractors
- reasonable surgical and medical services needed
- hospital treatment, services and supplies
- prescription medicines and supplies
- orthopedic appliances and supplies
Compensation benefits
If an injury or disease is found compensable, compensation benefits available in Pennsylvania include:
Replacement of lost wages. Approximately two-thirds of the workers’ salary for total disability (up to a maximum dollar amount provided by law) is paid for the time lost from work as a result of the work-related disability, if the disability lasts longer than seven calendar days. There is no maximum payment period. Payments are made for the duration of the disability.
Total disability benefits are paid for as long as an employee is unable to return to work as a result of a work-related injury or disease.
Permanent injury payments to compensate for loss of a body part.
Death benefits. If the injury results in death, surviving dependents may be entitled to benefits.
Workers’ Compensation Claims Process
- You must notify your employer of your injury within 120 days or lose your right to benefits. If you provide notice within 21 days, you are entitled to benefits from the date of the injury. After 21 days, you are entitled to benefits from the date you gave notice. (In some instances, e,g, occupational diseases or cumulative trauma injuries, the time for giving notice does not begin until the employee knows, or by the exercise of reasonable diligence should know, of the existence of the injury and its possible relationship to employment.)
- Your employer must immediately notify its insurance carrier of your injury.
- Your employer must present a list of medical providers from which you can choose a doctor to treat you for the first 90 days.
- Within 21 days from the date the employer receives notification of injury, the employer/carrier must either accept or deny liability for the injury. If the claim is denied, you have three years from the date you were injured or should have known you had a work-related injury to file a claim petition with the Bureau of Workers’ Compensation. These petitions are normally assigned to a Workers’ Compensation Judge.
- The judge holds a hearing to hear evidence presented by you and by your employer.
- After considering the evidence and applying the relevant legal provisions, the judge renders a decision.
- The judge’s decision can be appealed to the Workers’ Compensation Appeal Board, then to Pennsylvania’s Commonwealth Court, and finally to the Pennsylvania Supreme Court.
As you can see, navigating Pennsylvania’s Workers’ Compensation can be quite challenging for an employee. To speak with a knowledgeable personal injury attorney, call the Comitz Law at 570-829-1111 or email info@comitzlaw.com.