No fee until we win. You pay nothing unless we win your case.
No fee until we win. You pay nothing unless we win your case.
What do you need to know about workers' compensation in Pennsylvania? If you live here and were injured at work, or if you were injured while working anywhere in Pennsylvania, take a look at what you need to know about the state's workers' compensation system.
Workers' compensation (also known commonly as worker's comp or WC) is an employer-financed insurance program that covers an employee's lost wages and medical treatment costs after a work-related injury or illness. This program is different than regular employer-sponsored medical insurance and will only pay for medical expenses that are the direct result of injuries incurred in furtherance of an employer's business.
The state of Pennsylvania requires all employers to have workers’ compensation who employ one or more employees who could sustain a work-related injury in the state, could contract a work-related disease in the state, or could sustain a work-related injury outside of the state (provided the worker's primary place of employment is principally within the state or is under a contract of hire made within Pennsylvania).
Some employers are excluded from the state's workers' comp insurance requirements. These include employers who only have employees who fall under excluded categories.
According to the state of Pennsylvania, these categories include federal workers, longshoremen, casual workers who are not employees in the regular course of business, some types of at-home workers (those who aren't under the control of the employer's management and make, wash, clean, ornament, finish, alter, adapt, or repair articles or materials given to them for sale), some agricultural laborers, sole proprietors, LLCs who only have their own members as employees, some executive officers who have U.S. Department of Labor and Industry exclusions), and some licensed real estate salespeople.
If you do not fall under an excluded category, your employer should have workers' comp insurance. If your employer fails to carry workers' compensation insurance, there is a fund set up by the state to cover your injury. However, there are special rules that need to be followed in a time sensitive manner before you can recover benefits under the fund. Seasonal and part-time employees are also usually entitled to worker's comp.
You must report your injury to your employer so that a claim can be filed. Time is of the essence when reporting injuries or illnesses and filing claims. The information in the claim will help the insurance company to determine whether your injury or illness falls under the PA Workers' Compensation Act.
Workers' comp insurance doesn’t cover self-inflicted injuries, injuries that don't happen at work or as a result of the work that you do, and injuries or illnesses that are the result of a legal violation.
Never wait to report your injury or illness. Tell your manager, supervisor, or employer as soon as possible. If you don't notify your employer or don't report the injury or illness in the required time frame, you may not get worker's comp benefits.
Your employer is required to then report the injury to the workers' compensation carrier, who should file a First Report of Injury with the Pennsylvania Department of Labor and Industry. Thereafter, the insurance carrier has twenty-one (21) days to either accept or deny your claim.
Your employer should also provide you with a list of panel medical providers with whom you must treat for your injury for the first ninety (90) days. If you fail to treat with this panel, the workers' compensation carrier will not have to pay for your medical treatment and care.
No. There are instances when the employer can legitimately deny a claim. These scenarios could include when an employee fakes an injury, is injured in a non-work-related activity, contracts a disease that has nothing to do with their job or the place of employment, has no proof of an injury or disease, fails to report the issue, chooses to injure themselves, or is injured while engaging in an illegal activity at work.
However, many insurance carriers simply deny claims without any basis to issue the denial. If you receive a denial of your claim, or the carrier simply does not acknowledge your injury, you must file a Claim Petition with the Pennsylvania Department of Labor and Industry. This is a very complicated process and you should talk to an attorney about your rights.
The claim petition and hearing are complex legal matters. A workers' comp attorney has the knowledge and experience to help you navigate this process. Our attorneys are seasoned and experience in handling workers' compensation claim and are ready to help you fight for what you are owed.
Were you denied worker's compensation? Contact Porta-Clark and Ward for more information.