Coverage begins on the date of hire. Medical benefits are payable from the first day of injury.

Total Disability Benefits apply to injured workers for a period during which they are considered totally disabled and unable to work. After 104 weeks of such status, the employer/insurer can require a medical examination to determine if the employee is at least 50% impaired based upon the employee’s work injury according to American Medical Association standards. If the 50% threshold is not met, the employee’s status can change to partial disability.

Partial Disability Benefit status is for a maximum of 500 weeks. If, while on partial disability status, you obtain a qualified impairment rating physician’s determination of impairment which is equal to or greater than 50%, you may file a Petition for Reinstatement of total disability status.

Partial disability of up to 500 weeks of benefits are paid if you can return to work at a lower paying job within work-related restrictions or you are found not totally disabled.

Most Pennsylvania workers are covered by the Pennsylvania Workers Compensation Act. Employers must provide coverage for all of their employees, including seasonal and part-time workers. Non-profit corporations, unincorporated businesses, and even employers with only one employee, must comply.

Some Pennsylvania employees may be covered by other compensation laws, rather than the Pennsylvania Workers’ Compensation Act, including: Federal civilian employees, railroad workers, longshoremen, shipyard and harbor workers. Some others who may not be covered are volunteer workers, agricultural laborers, casual employees, domestic employees and employees who have been granted a personal religious exemption from the Act. Certain types of executive officers of for-profit and not-for-profit corporations may elect exemption from the Act.

There are several different types of workers compensation benefits including payments for lost wages, death benefits, specific loss benefits and medical benefits.

Wage-loss benefits are available if it is determined that you are totally disabled and unable to work or partially disabled and receiving wages less than your pre-injury earnings.

If the injury results in death, surviving dependents may be entitled to benefits.

If you have lost the permanent use of all or part of your thumb, finger, hand, arm, leg, foot, toe, sight, hearing, or have a serious and permanent disfigurement on your head, face or neck, you may be entitled to a specific loss award.

In the event of a work-related illness or injury, you are entitled, if covered under the Act, to the payment of related reasonable surgical and medical services rendered by a physician or other health care provider. There are certain obligations that you must meet in order to receive Medical Care Benefits, including choosing a provider from a list that your employer provides.

Medicine, supplies, hospital treatment and services, orthopedic appliances, and prostheses are also covered for as long as they are needed. Even if you have lost no time from work, health care costs for a work-related injury or illness are payable at the fee schedule rate. However, an employee may not be charged the difference between the health care providers charge and the amount paid by the employer or its insurance carrier. In other words, there can be no “balance billing” or a co-payment to you.*

*Please be warned that, if you seek medical treatment outside the Commonwealth of Pennsylvania, you may be subject to the risk of balance billing by the medical provider. You should discuss this with your medical provider prior to initiating treatment.

If your employer has posted a list of six or more physicians or health care providers in your workplace, then you are required to visit one of them for initial treatment. You should continue treatment with that provider or another on the list for a period of 90 days following the first visit. You may see any provider on the list; your employer may not require or direct you to any specific provider on the list.

If a listed provider prescribes invasive surgery, you are entitled to a second opinion which will be paid for by your employer/insurer. Treatment recommended as a result of the second opinion must be provided by a listed provider for 90 days.

If during the 90-day period you visit a provider(s) not on the list, your employer or your employer’s insurance carrier may refuse to pay for such treatment. After the 90 days, as well as in situations where your employer has no posted list or an improper list, you may seek treatment with any physician or other health care provider you select. You must notify your employer of the provider you have selected. During treatment, the employer or the employer’s insurance carrier is entitled to receive monthly reports from your physician or provider.

Injured workers should be advised that your health care providers may need information concerning your claim. Some of this information may be contained in correspondence you receive from your insurance carrier, and you may want to provide copies of letters or forms to your health care provider.

If your work causes an injury, illness or disease, you may be entitled to workers compensation. No compensation will be paid if an injury or death is self-inflicted, or is caused by an employee’s violation of the law including, but not limited to, the illegal use of drugs. An injury or death caused by intoxication also may not be covered.

Some occupational diseases are covered if caused by or aggravated by your employment. Your disability must occur within 300 weeks of your last employment in an occupation where you were exposed to the hazard. 

For certain lung diseases like mesothelioma, you must have worked in an occupation with a silica, coal or asbestos hazard for at least two years in Pennsylvania during the ten years prior to your disability.

Submit a new question


Benefits for Lost wages

If your request for workers compensation benefits is denied by your employer or your employer’s insurance carrier, you have three years from the date of injury to file a Claim Petition.

In occupational disease cases, injury/disability must occur within 300 weeks from the date of last employment in an occupation in which you had exposure to a hazard, and a petition must be filed no later than three years from the date of injury/disability.

Failure to file a petition on a timely basis may result in forfeiture of your right to benefits.

If your benefits were terminated, you may file a Petition to Reinstate workers compensation benefits within three years after the date of your most recent workers compensation check.

If your benefits were suspended, you may file a petition to have benefits reinstated. This petition must be filed within 500 weeks from the date of suspension.

Wage-loss benefits can be stopped by an employer/insurer who has evidence that you have returned to work at wages equal to or more than your earnings level prior to the injury and after providing a timely notice of that fact. In addition, if you are receiving temporary compensation benefits during the 90 days following the report of injury, the insurance carrier/employer may notify you they are stopping benefits because they are not accepting the claim of a work-related injury.

Other reasons that benefits may be stopped include: a workers compensation judge stopped benefits after a hearing; the employee signs either a Supplemental Agreement or an Agreement to Stop Workers Compensation (commonly referred to as a Final Receipt); the 500-week period of partial disability status expires.

You must be disabled more than seven calendar days (including weekends) before workers compensation payments for disability are payable. Benefits for time lost from work are payable on the eighth day after injury. Once you have been off work 14 days, you receive retroactive payment for the first seven days.

If you report the injury promptly, miss more than seven days of work and your claim is accepted by the insurance carrier, you should receive your first compensation check within 21 days of your absence from work. After that, you will receive a check on a regular basis.

Payments of temporary compensation may be made by your employer or the insurance carrier for up to 90 days, even if your claim is not accepted by your employer or its insurance carrier. If your employer or their insurance carrier advises you that it will not continue your temporary compensation checks past 90 days, you have the right to file a Claim Petition with the bureau for a hearing if you believe you are entitled to benefits.

Wage-loss benefits are equal to approximately two-thirds of your average weekly wage, up to a weekly maximum. Workers compensation wage-loss benefits can be offset for 50% of Social Security “old age” benefits, the employer-paid portion of a retirement pension, severance pay, unemployment compensation or earnings the employee receives. The law does not allow for a cost-of-living increase for employees who have been hurt on the job.

There are several different ways of calculating the average weekly wage under the Act. The minimum compensation rate is the lower of 90% of the workers average weekly wage or 50% of the Statewide average weekly wage.

If you have been receiving benefits and your employer has evidence to prove that employment is available to you, within your medical restrictions and in your local area, you may receive an offer of employment. You have the right to either accept or decline the job offer.

If you decline the job offer, the employer may petition a workers’ compensation judge to either modify or terminate your benefits based upon your unwillingness to take that job. The insurer/employer must continue to pay benefits during the hearing process unless the judge orders otherwise.

In open hearings, the judge will evaluate medical evidence, both from you and your insurer/employer, on the availability of the work and your ability to do it, before rendering a decision.

Payment of medical benefits by your employer does not mean that your claim has been accepted or reopened.

If your benefits were terminated, you may file a Petition to Reinstate workers compensation benefits within three years after the date of your most recent workers compensation check.

If your benefits were suspended, you may file a petition to have benefits reinstated. This petition must be filed within 500 weeks from the date of suspension.

Payment of medical benefits by your employer does not mean that your claim has been accepted or reopened.

Please visit our Pennsylvania Workers Compensation Information Center for more information.

Under the Act, any worker who has filed a petition for total or partial disability benefits or who is receiving such benefits is required to report, in writing to the insurer, any information which is relevant in determining entitlement to, or amount of, compensation including, but not limited to, information regarding the receipt of wages from another employer or from self-employment. The worker is obligated to cooperate with the carrier in an investigation of employment, self-employment, wages and physical condition.

Unless an employer has knowledge of the injury or the employee gives notice to the employer within 21 days of the injury, no compensation is due until notice is given. Notice must be given no later than 120 days after the injury for compensation to be allowed. If your request for workers compensation benefits is denied by your employer or your employer’s insurance carrier, you have three years from the date of injury to file a Claim Petition.

In occupational disease cases, injury/disability must occur within 300 weeks from the date of last employment in an occupation in which you had exposure to a hazard, and a petition must be filed no later than three years from the date of injury/disability.

Failure to file a petition on a timely basis may result in forfeiture of your right to benefits.

If your benefits were terminated, you may file a Petition to reinstate workers compensation benefits within three years after the date of your most recent workers compensation check.

If your benefits were suspended, you may file a petition to have benefits reinstated. This petition must be filed within 500 weeks from the date of suspension.

Payment of medical benefits by your employer does not mean that your claim has been accepted or reopened.