The Truth About Workers’ Compensation in Pennsylvania
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How Workers’ Compensation Really Works In PA
The Pennsylvania workers’ compensation system sets out specific benefits for injured workers and clear limits on what is and is not covered.
Benefits Available
As a general rule, a work related injury entitles the claimant to workers’ compensation benefits, including:
- Payment of reasonable and necessary medical bills related to the work injury
- Wage loss benefits, when the injury causes a loss of earnings
A work injury can qualify for medical benefits even if the worker never misses a day of work.
The wage loss benefit rate is determined by law. It is not paid dollar for dollar, but it is not taxable. For most workers it is about two-thirds of the pre-injury average weekly wage, up to a maximum set for the year of injury. For injuries in 2026, the maximum is $1,394 per week.
Permanent loss of use of a body part and serious, permanent scarring of the head, neck or face may yield a fixed award, known as a specific loss benefit.
There is no award for pain and suffering in the workers’ compensation system.
The System
Workers’ Compensation is an administrative agency system. It is not part of the Court of Common Pleas.
Judges handle only workers’ compensation claims and have no jurisdiction to decide any other issues.
There are general rules applicable to every judge in every county of Pennsylvania. Judges also have some flexibility to establish and enforce certain rules and procedures on their own.
A contested workers’ compensation petition commonly takes months to litigate because both sides need time to present testimony, medical evidence and other proof before the judge issues a decision. During that time, there are multiple hearings to ensure all evidence is obtained and presented pursuant to deadlines established by the judge.
Video hearings are conducted by most judges since COVID, although in person hearings may be ordered or requested in certain circumstances.
Types of Petitions
Disputed cases are litigated through formal petitions. A more detailed explanation of workers’ compensation petitions is available if you want deeper guidance.
Claim Petition
A Claim Petition is used to seek benefits when a claim has been denied or ignored.
The injured worker has the burden to prove all elements required to support an award of benefits, including that a work injury occurred in the course of employment and that the employer was timely and properly notified. A worker seeking wage loss benefits must also prove that the injury caused a disability, meaning a loss of earning power. A claim for medical benefits alone does not require time lost from work.
The employer has the burden to prove any defenses, such as an injury that was intentionally self-inflicted, an injury caused by the worker’s violation of law, an injury that would not have occurred but for the worker’s intoxication, or an attack by another person for purely personal reasons unrelated to work. Breaking a workplace rule is not automatically a defense.
Review Petition
A Review Petition may be filed by either the injured worker or the employer if there was a mistake in the way the claim was accepted.
The most common issues involve the description of injury and the pre injury average weekly wage and benefit rate. The burden of proof is on the party seeking to change the originally accepted terms.
Termination Petition
A Termination Petition is filed by the employer or insurance carrier to stop payment of all benefits based on evidence that the injured worker is fully recovered.
The evidence is most commonly an opinion from a doctor hired by the insurance company.
Modification or Suspension Petition
A Modification or Suspension Petition is filed by the employer or insurance company to reduce or stop wage loss benefits, most often on the theory that:
- Work is available to the claimant within their physical restrictions, or the claimant has the earning power to perform such work
- The claimant has returned to work at earnings equal to or greater than before the injury, or turned down a suitable job that paid as much
Each situation involves numerous elements the employer must prove. A modification or suspension affects wage loss benefits only. The employer remains responsible for reasonable and necessary medical treatment of the work injury.
Impairment Rating Evaluation
An Impairment Rating Evaluation (IRE) is a separate process. After a claimant has received 104 weeks of total disability benefits, the insurer may request an IRE. If the claimant’s whole-body impairment is rated below 35%, the claimant’s status can be changed from total to partial disability.
That change does not reduce the weekly benefit or stop medical benefits. It limits the remaining wage loss benefits to 500 weeks of partial disability. More on how this works is on our wage loss benefits page.
Reinstatement Petition
A Reinstatement Petition is filed by the injured worker to restore benefits after they were modified, suspended or terminated, when the worker’s condition or earnings have changed and disability from the work injury has returned. Deadlines apply, and reinstating benefits after a termination is much harder than after a suspension.
Petition for Penalties
A Penalty Petition may be filed by the claimant if the employer or insurance company has violated a provision of the Workers’ Compensation Act, requesting that a penalty be imposed.
Utilization Review Request or Petition
The utilization review process begins with a request seeking review of treatment records to determine whether the treatment plan is reasonable and necessary.
If either party disputes the determination, a petition may be filed and the issue is decided by a judge.
Petition Seeking Approval of a Compromise and Release
A Compromise and Release is a settlement in the workers’ compensation forum. Workers’ compensation cases cannot be settled out of court. All settlements must be approved by a Workers’ Compensation Judge.
If you are considering settlement, it is critical to understand that a settlement is generally final. Learn more about workers’ comp settlements.
The purpose of the hearing is for the judge to confirm that the injured worker understands the full legal significance of the agreement: the terms and conditions, the options that have been explained, and the rights being given up. Once approved, a Compromise and Release can be set aside only in rare circumstances, such as fraud. Benefits the agreement does not resolve, for example medical benefits left open, remain available.
No one can force either party to settle a workers’ compensation case. Not the attorneys, not the judge, and not the appellate courts.
If the parties do not settle, the judge will determine whether benefits continue, are modified, or are terminated.
The Judge
In the workers’ compensation system, the judge has sole and exclusive authority to determine the facts of the case.
Each side may present whatever evidence it believes is necessary. If one side presents testimony from ten doctors and the other side presents testimony from one doctor, the judge may still choose to believe the single doctor.
Appeal courts do not reevaluate the evidence. They only determine whether the judge acted within authority, whether there is some evidence supporting the decision, and whether the law was applied correctly.
The Lawyer
This information represents only a small portion of workers’ compensation law. It is a complex and constantly evolving field.
The Pennsylvania Bar Association and the Supreme Court of Pennsylvania recognize this complexity through a specialist certification for lawyers who dedicate their practice to workers’ compensation, meet experience requirements, and pass written examinations. Three of our partners, Mark R. Schmidt, Vasil L. Kirifides and Anna V. Rio, are Certified Workers’ Compensation Specialists.
Even lawyers who dabble in workers’ compensation law often lack the day to day knowledge required to handle these cases effectively.
All information above is general. Specific rules, procedures, and issues can vary from case to case.
If you have been injured at work, you need the experience of a certified specialist. If you need help, speak with our Workers’ Compensation Lawyers. Call 610-892-9300 or text 610-255-7183 for a free consultation.