Pennsylvania Workers’ Compensation Timelines: What Happens and When
Reviewed for legal accuracy by
When you are dealing with an injury, you probably feel that everything in your claim should happen as soon as possible. After all, you have pain, bills and a lot more complexity than normal in your life.
Employers and insurance companies do not always share that urgency. Knowing the general timeline of a Pennsylvania workers’ compensation claim helps you set expectations, spot delays that aren’t allowed and plan your next move.
Denials and eligibility
One of the biggest delays in a valid workers’ compensation claim is a denial. Insurance companies deny claims for various reasons. One of them might be that you are not eligible.
However, you should know that almost every employee in Pennsylvania is covered. Even companies with only one employee have to follow the workers’ comp law. Coverage is no-fault, but narrow statutory defenses can apply, such as an injury that would not have occurred but for the worker’s intoxication or an injury caused by the worker’s violation of law. The employer has the burden of proving the defense.
Timelines and delays
Here is the usual sequence of a Pennsylvania claim, and the timing that applies at each step:
- You report the injury. Tell your supervisor as soon as possible. Under the Workers’ Compensation Act, notice within 21 days protects your benefits from the first day of disability. Notice after 21 days but within 120 days generally means benefits start from the date you reported, and after 120 days the claim can be barred unless an exception applies.
- Your employer notifies its insurer. The employer passes your report to its workers’ compensation insurance company, or handles it directly if it is self-insured.
- The insurer responds within 21 days. The 21 days run from when the employer has notice or knowledge that the injury has disabled you, not from the date you were hurt. The insurer must accept the claim, pay it temporarily or deny it, and send you the matching notice.
- Temporary compensation, if the insurer is still investigating. An insurer that isn’t sure can pay under a Notice of Temporary Compensation Payable for up to 90 days without admitting liability. It isn’t an extension on top of the 21 days; it is a limited investigation period. If the insurer wants to stop, it must send the proper stopping and denial notices on time. If it doesn’t, the claim is generally treated as accepted.
- Wage-loss checks, if you are out of work. Wage-loss benefits start once you have been disabled for more than seven days, and if you are out 14 days or more, the first week is paid as well.
- A Claim Petition, if the claim is denied. A denial is not the end. A Claim Petition generally must be filed within three years of the injury, and the case then goes before a Workers’ Compensation Judge.
There are various other timelines, especially if your claim ends up going to the workers’ compensation courts. A disputed case usually involves several hearings over a period of months, and either side can appeal the judge’s decision. For every filing deadline in one place, see our list of workers’ compensation deadlines you can’t afford to miss.
Formal procedures can feel like unnecessary delays when you are waiting on money you need. An experienced lawyer knows how to keep a case moving and when an insurer’s delay crosses the line into a violation that can support penalties. Call 610-892-9300 or text 610-255-7183 to see how our dedicated workers’ compensation attorneys can help cut through the red tape.