The Truth About Workers’ Compensation in Pennsylvania
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:
- Wage loss benefits
- Payment of reasonable and necessary medical bills related to the work injury
The wage loss benefit rate is determined by law. It is not paid dollar for dollar, but it is not taxable.
Permanent loss of use of a body part and scarring above the collar bone may yield a fixed award.
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.
The average petition can take approximately six to nine months before a decision is issued. 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 the injury occurred in the course of employment, resulted in disability, and that the employer was timely and properly notified.
The employer has the burden to prove any defenses, including allegations that the injury resulted from a policy violation, intoxication, or personal reasons unrelated to work.
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 challenge wage loss benefits based on one of two theories:
- There is work available to the claimant within their capabilities
- The claimant has an impairment of bodily function of less than fifty percent
Each situation involves numerous elements the employer must prove.
Reinstatement Petition
A Reinstatement Petition is filed by the injured worker when benefits have been modified, suspended, or terminated and the reason for stopping benefits has changed and disability has recurred.
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 to ensure the injured worker understands the terms and conditions, all options have been explained, all questions have been answered, and the injured worker understands the settlement cannot be reopened except as specifically stated in the agreement.
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.
Even lawyers who dabble in workers’ compensation law often lack the day to day knowledge required to navigate this system 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.