Important: We updated this article in October 2023 to make sure all info below is both current and correct. Each state has its own individual process in place for injured workers filing workers’ compensation claims. If you develop an occupational disease or work injury in Pennsylvania, learn the steps you’ll take to receive workers’ compensation benefits below. We also have a handy chart showing Pennsylvania workers’ compensation program data from recent years.
Which Workers Aren’t Automatically Covered Under the Pennsylvania Workers’ Compensation Act?
Every employer with at least one part time or full time employee must carry Pennsylvania workers’ compensation insurance. However, certain employees are exempt from this workers’ compensation insurance coverage under Pennsylvania law, including:
- Federal employees
- Railroad workers
- Volunteers
- Agricultural laborers
- “Casual” employees (i.e., people employed temporarily in positions without regular hours)
- Domestic workers employed in the household
- Longshoremen
- Shipyard and harbor workers
If you work as a seasonal, part time, or full time employee, your coverage begins on day one at your job.
Important: Federal employees use a different process to claim workers’ compensation benefits.
How to File Your Pennsylvania Workers’ Compensation Claim
According to the Pennsylvania Department of Labor & Industry, follow these steps to apply for workers’ compensation benefits:
1. Notify your employer as soon as possible (but within 21 days) about your work related injuries.
Fail to report it within 120 days, and Pennsylvania workers’ compensation law prevents you from drawing any benefits.
2. Pennsylvania law requires you to see 1 of 6 doctors authorized by your employer to provide work injury medical treatment.
During the first 90 days, workers’ compensation requires you to seek medical care within your employer’s network. After that, you can seek medical treatment for work related injuries from any doctor you choose.
Important: If your employer fails to give you a company doctor list to choose from, then you can seek medical care anywhere.
3. If a work injury makes you miss at least one job shift, then your employer must file a First Report of Injury Form.
Your employer should file your FROI form with the State Workers’ Insurance Fund (SWIF) or their insurer. Be sure to ask a copy of the FROI for your own records.
4. Your employer’s insurer or the State Workers Insurance Fund must either approve or deny your claim within 21 days, and in writing.
In some cases, the insurance company or SWIF can extend your claim’s initial review period by 90 days. Whenever this 90-day extension occurs, you’ll usually receive temporary compensation payable during that period.
5. If the insurer awards you workers’ compensation benefits, you should receive an Agreement for Compensation (LIBC-336) letter in the mail.
Your employer may also require an examination with their preferred provider to confirm your work injury or illness. If you refuse this exam, you may lose your right to benefits under the Pennsylvania workers’ compensation act.
6. You must miss at least seven calendar days of work before you can receive wage loss benefits.
Benefits for lost wages can begin on your eighth missed workday after reporting your work related illness or injury. Your first seven days off are unpaid, unless you miss at least 14 days of work. Then, workers’ compensation insurance pays wage loss benefits for your first week off.
If approved, PA’s average weekly wage determines how much money you’ll get paid in wage loss benefits. For 2023, the most Pennsylvania workers’ compensation pay you can receive for wage losses is $1,273 per week. Injured workers who don’t need at least one week off to recover cannot get wage-loss benefits. Instead, the employer’s insurance company only pays your medical bills, not for time off from work.
Pro Tip: Awarded Pennsylvania workers’ comp benefits? Then the insurance company must start paying for lost wages within 10 days. You may receive those workers’ compensation benefits for up to 500 weeks. If you’re totally disabled, you can receive total disability benefits for up to 104 weeks. After that, you must undergo an employer-required medical exam.
7. You’ll receive a mailed Notice of Workers’ Compensation Denial (LIBC-496) letter if you’re denied benefits.
Pennsylvania workers’ compensation law requires you to first try to settle your dispute through mediation. If mediation fails, then you can request a workers comp’ appeals hearing from the Bureau of Workers’ Compensation.
8. To appeal, request a hearing by filing a Claim Petition (LIBC-362) with the Bureau of Workers’ Compensation.
You must plead your case before a Pennsylvania workers’ comp judge within three years. Once you reach this point, you really need a Pennsylvania workers’ compensation attorney on your side.
Since each Pennsylvania workers’ compensation case is different, your own experience may vary. You may also wish to review these FAQs from the Pennsylvania Bureau of Workers’ Compensation.
Pennsylvania Workers’ Compensation Statistics
The annual workers’ compensation report from the Bureau of Labor Statistics (BLS) includes program data for most states. This yearly report shows total workers’ compensation claims, those who changed jobs or missed work, and claims by job sector. Learn how Pennsylvania workers’ compensation claims changed from 2017 to 2021 in our chart below:
During this period, service employees filed nearly 7 in 10 claims per year, on average (66%-70%). Total workers’ compensation claims fell 10% at the start of the pandemic in 2020 and barely rose in 2021. At least half of all injured workers qualify for lost wage benefits (50%-61%). If your injury isn’t bad enough to need time off to recover, then workers’ comp only covers your medical bills.
How to Get Free Expert Workers’ Comp Claim Help
Still have questions about how to get the benefits you’re owed under the Pennsylvania workers’ compensation act? Sign up for a free phone call with a workers’ comp attorney who can answer your specific questions. You’ll also pay nothing out of your own pocket for help with your appeal.
All workers’ comp attorneys work on contingency. That means they charge $0 for expert help unless an injured worker receives workers’ comp benefits. And if you’re successful, then you only pay one small fee after your award comes through.
Want free expert claim help? Click the button below to start your free online benefits quiz now and see if you may qualify:
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Lori Polemenakos is Director of Consumer Content and SEO strategist for LeadingResponse, a legal marketing company. An award-winning journalist, writer and editor based in Dallas, Texas, she's produced articles for major brands such as Match.com, Yahoo!, MSN, AOL, Xfinity, Mail.com, and edited several published books. Since 2016, she's published hundreds of articles about Social Security disability, workers' compensation, veterans' benefits, personal injury, mass tort, auto accident claims, bankruptcy, employment law and other related legal issues.
