Understanding the workers’ compensation process in Pennsylvania
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The workers’ compensation system in Pennsylvania follows a set order: you report the injury, get medical care, the insurance company accepts or denies the claim, and a Workers’ Compensation Judge decides any dispute. Workers’ compensation is a no-fault program that pays for medical treatment and replaces part of your lost wages when you are hurt or become sick because of your job.
Knowing each step helps you avoid the mistakes that delay benefits, and helps you recognize when your employer or its insurer isn’t handling the claim correctly.
Report the injury
The first step in the workers’ compensation process is to report the injury to your employer. Tell your supervisor as soon as possible, and within 21 days if you can; that protects your benefits from the first day you were disabled. If you report later but within 120 days, benefits generally start only from the date you reported, and after 120 days the claim can be barred unless an exception applies. Reporting quickly also helps document the injury accurately and starts the process sooner. Your employer then has a responsibility to report the injury to its workers’ compensation insurance carrier.
Seek medical attention
If the injury is an emergency, get emergency care first, at any hospital, and report the injury as soon as you reasonably can. For non-emergency care, check whether your employer has posted a list of designated health care providers. If the list is valid and you were properly notified of your rights, you generally must treat with a provider on that list for 90 days from your first visit. Your employer can’t require you to see one specific doctor; you can choose among the providers on the list. Follow your doctors’ advice and keep records of your treatment, since they will be important for your claim. Learn more about medical benefits for a work injury.
The claim process
Once the employer has notice or knowledge that the injury has disabled you, its insurance company generally has 21 days to accept the claim, pay it temporarily while it investigates, or deny it. If the claim is accepted, you will receive workers’ compensation benefits:
- Medical benefits for reasonable and necessary treatment of the work injury, whether or not you miss work
- Wage-loss benefits of about two-thirds of your average weekly wage, up to a maximum set for your year of injury, once you have been disabled for more than seven days
How much and how long you are paid depends on your wages and on your ability to work and earn, not simply on how severe the injury is. Wage-loss benefits continue while you are disabled, can be reduced if you return to work at lower pay, and can change if the insurer proves you can work.
If they deny your claim
If the insurance company denies the claim, you do not appeal the denial. You challenge it by filing a Claim Petition, generally within three years of the injury. The petition is assigned to a Workers’ Compensation Judge, who holds hearings and decides whether benefits are owed. An appeal comes later, and only if you or the insurer disagrees with the judge’s decision. Our page on denied workers’ compensation claims explains how we handle these cases.
Each step must be handled carefully to make sure injured workers receive the benefits the law provides, so you can focus on your recovery. If you were hurt at work, contact YOUR Workers’ Compensation Specialist for a free, no obligation consultation to learn how we can help you. Call 610-892-9300, text 610-255-7183 or reach us online.