Workers’ Compensation – Types of Benefits

Being injured on the job is one of the worst things that can happen to a worker. What is going to happen next? How am I going to be able to work? When can I return to work? How do I file a workers’ compensation claim? Do I need a workers’ compensation attorney to help me?

In Pennsylvania, it is the law that if a worker has been injured on the job, they are entitled to workers’ compensation benefits. This assumes that the company you work for does have workers’ compensation. If they do not, this is something you need to discuss with an experienced workers’ compensation attorney at Placidi, Parini, Grasinger & Page.

It is the law in Pennsylvania that most employers are required to have workers’ compensation insurance. But some employers do not. Check to see if your employer has insurance by going to the Pennsylvania Department of Labor & Industry website.

What Happens If Your Employer Does No Have Workers’ Compensation

Consult an experienced workers’ compensation attorney at Placidi, Parini, Grasinger & Page immediately. Some options may be open to you, and we can outline those for you. It depends on the circumstances of your case.

If there are no options, you may apply for benefit from the Uninsured Employer Guaranty Fund. Act quickly, as you only have 45-days to file after you find out your employer is not insured. You must also file an accident report with your employer within the first 120 days after your accident at work.

You need to file a claim with the Department of Labor & Industry to petition payment from the Fund. You are also obligated to file a notice of claim against your uninsured employer.

Know Your Benefits

Make sure you are aware of the benefits that you are entitled to if you are injured or become ill at work because what you do not know can significantly impact your claim by affecting what type of benefits and how much you receive.

You do not have to miss work to receive Pennsylvania workers’ compensation payments for your medical expenses. They are independent of lost wage payments and other benefits.

Types of Workers’ Compensation Benefits 

Pennsylvania law provides the following workers’ compensation benefits:

Lost wages – A lost wages benefit kicks in if you are totally disabled and unable to work, or you are partially disabled and paid wages less than what you were earning prior to your injuries.

Total disability benefits (TDB) – Total disability benefits are paid out as long as you cannot work. There is no time limit to collect this benefit. However, if you have been paid TDB for 104 weeks (2 years), you are typically asked by the workers’ compensation insurance carrier to have an Impairment Rating Evaluation (IRE). If you are found to have less than 50 percent total body impairment, your TDBs last a maximum of 500 weeks, and you are partially disabled. The benefit payment remains the same, and the insurance carrier can attempt to reduce a partial disability benefit further via vocational rehabilitation during the 500 weeks.

Partial disability benefits (PDB) – PDBs are usually received when the injured worker is back to work, but the wages received are lower than wages paid before being injured. PDBs are payable for up to 9.6 years, at which point your workers’ compensation status is determined as a result of an IRE, or a judge finds you can handle light-duty work at lower wages. Should you return to work, but a new job you are doing pays less than the job you performed before being injured, you are entitled to be paid two-thirds of the difference between the average weekly wage you received in your old job and your new position to the maximum rate for the year of your injury.

Medical treatment – Being injured on the job in Pennsylvania or being diagnosed with a work-related illness means you receive reasonable and necessary treatment. The cost for this is your employer’s responsibility and that of the workers’ compensation carrier. On acceptance of a claim, you do not have to make a co-payment or any other fee for medical treatment related to your injury or illness. Be prepared to have the relevance of your treatment challenged by the insurance carrier. Be aware that injuries are often described very minimally to limit long-term payments. Ensure you know which injuries are accepted by the insurance carrier and which are not.

Death benefits – These benefits go to the surviving dependents in case of death.

Specific loss benefits (SLB) – SLBs apply in circumstances where a worker has lost the permanent use of all, or part of a thumb, hand, finger, foot, leg, toe, sight, or hearing, or there is a serious disfigurement involving the face, neck or head.

Scar benefits – Scars affect people’s lives and are a living reminder of an accident or illness. It affects one’s emotional wellbeing. Adjusting to how you look with a scar changing your appearance is difficult. 

Hearing loss – This is a common work-related injury, despite employers being mandated by law to regulate noise levels. Losing your hearing can cause permanent damage, affecting your ability to earn a wage and the quality of your life.

Covered Medical Expenses

Pennsylvania workers’ compensation covers the following expenses:

  • Visits to see your doctor – if your employer has a list of company doctors, you have to see them for 90-days to get workers’ compensation benefits. If there is no list, go to your doctor.
  • Surgical costs
  • Expenses at the hospital such as X-rays, ER trips, overnight stays
  • Testing to diagnose the problem
  • Medications and/or other prescriptions
  • Orthopedic services
  • Medical supplies
  • Prostheses
  • Physical therapy

Contact an Attorney

While this may sound straightforward, it often is not the case, as insurance companies would rather find an issue to dismiss or deny benefits. This is one of the main reasons you would be best served to file your claim by discussing your case with the experienced workers’ compensation attorneys at Placidi, Parini, Grasinger & Page. We bring you up to speed on your legal rights, how to file, what to expect and how it may affect you. We make sure you have the correct information to make an informed decision about your case.