Pennsylvania Workers’ Compensation Frequently Asked Questions
Injured at work? You are not alone. Most injured workers in Delaware County, Philadelphia, and across Pennsylvania ask the same questions: What benefits am I entitled to? Can the insurance company stop my checks? What is my claim really worth?
- Settlements
- Case Value
- Available Benefits
- Wage Loss Rate
- Claim Denials
- Stopping Benefits
- IME Exams
- How Long Cases Last
- First Check Timing
- Choosing Your Doctor
- Notice of Ability to Return to Work
- What Is an IRE
- Light Duty Offers
- Remote Work Injuries
- Are Benefits Taxable
- Suing a Third Party
- Can I Be Fired
- Surveillance & Social Media
- Why Hire a Lawyer
▸ Can I get a settlement for my workers’ compensation claim?
Yes, but it is never automatic. In Pennsylvania, settlements are voluntary. A Judge cannot force either side to settle.
What drives settlement value
- Your weekly benefit rate
- How long disability is expected
- Accepted injuries and future medical needs
- The Judge, defense doctor, and insurer strategy
Insurers often start with low offers. The key is leverage — insurers pay more when they know your lawyer will fight through hearings and appeals.
▸ What’s my workers’ compensation claim worth?
There is no fixed number. Two workers with the same injury can get very different offers based on wage rate, strength of medical evidence, Judge assignment, and litigation risk.
Pennsylvania workers’ comp does not pay for pain and suffering. Value comes from wage loss, medical coverage, and how hard your attorney pushes the insurer. Cases with strong representation are worth more.
▸ What benefits are available for my work injury?
- Wage loss benefits — a portion of your average weekly wage
- Medical coverage — payment of reasonable and necessary treatment
- Specific loss or disfigurement — amputations, permanent loss of use, or scars above the collarbone
- Fatal claim benefits — for surviving dependents
There is no payment for pain and suffering in workers’ compensation, so maximizing wage loss and medical is critical.
▸ How is my wage loss benefit rate determined?
It is calculated from your average weekly wage in the year before your injury. The Bureau of Workers’ Compensation updates annual minimums and maximums.
Because comp checks are not taxable, they are less than your gross pay but designed to approximate take-home income. Errors are common — auditing your rate can mean thousands of dollars.
▸ Why would the insurance company deny my claim?
- Claiming the injury was not witnessed
- Blaming a pre-existing condition
- Alleging a workplace policy violation
- Accepting only “minor” injuries while ignoring serious ones
Even when a claim is accepted, the insurer may limit your injury description or understate your wages. Every detail should be checked — and challenged if wrong.
▸ Can the insurance company stop my benefits?
Yes. Insurers commonly file to:
- Terminate — claim you are fully recovered
- Suspend — argue you can earn your pre-injury wages
- Modify — reduce benefits based on lower-paying work or an IRE
If a Judge agrees, your checks can stop. Countering their medical and vocational evidence requires experienced advocacy.
▸ What is an Independent Medical Exam (IME)?
An IME is scheduled by the insurer and performed by a doctor they choose and pay. Despite the name, it is not truly independent.
Why IMEs matter
- The report often minimizes or denies your injury
- Insurers use it to try to stop or cut benefits
- You must attend a properly scheduled IME, but you do not have to accept the opinion
A certified lawyer will prepare you for the IME, obtain your treating doctor’s opinions, and challenge any biased findings.
▸ How long do workers’ compensation cases last?
It depends on whether your claim is accepted, whether litigation is needed, and whether you settle.
Typical timelines
- Accepted claims — first payments can begin within about 21 days of notice and continue while you remain disabled or until the insurer lawfully changes status.
- Denied claims — a full litigation cycle to a Judge’s decision often takes about 9–12 months; appeals add more time.
- Settlements — can occur any time; many follow an IME or when treatment stabilizes. After agreement, a hearing is usually set within weeks and payment follows Court approval.
- Status changes — events such as an IRE at 104 weeks can change your status without ending the case.
Your lawyer’s job is to protect benefits now and time any settlement to your best interest.
▸ How long until I get my first workers’ comp check?
If your claim is accepted, the insurer should begin paying within about 21 days of receiving notice of your injury. If you do not receive payment on time, call us — there may be a temporary acceptance, a wage rate error, or the insurer may be preparing to deny or limit the claim.
▸ Can I choose my own doctor for workers’ comp in Pennsylvania?
If your employer has a valid list of panel providers, you may need to treat with them for the first 90 days. After 90 days you can choose your own doctor. If the list is not valid, you can choose from the start.
▸ What is a Notice of Ability to Return to Work?
It is a form the insurer sends when it receives medical information about your work capacity. It does not end benefits by itself, but it often precedes job offers, vocational activity, or a petition to change your status. Do not ignore it — call us so we can respond and protect your rights.
▸ What is an IRE in Pennsylvania workers’ compensation?
An Impairment Rating Evaluation can change your status from total to partial disability if the whole person impairment is below the legal threshold. Partial status limits wage-loss weeks. These exams can be challenged with medical and legal arguments.
▸ Do I have to accept a light duty job offered by my employer?
If the job fits your medical restrictions, refusing it can harm your case. If it exceeds your restrictions or is not truly available, you can challenge it. Get legal advice before you decide.
▸ Are injuries while working from home covered?
Often yes, if the injury occurs in the course and scope of employment.
Examples
- Covered — tripping while answering a work call, lifting work equipment, injuring yourself using office devices
- Not covered — falling over household clutter, cooking for family on a break
▸ Are workers’ compensation benefits taxable?
Workers’ comp wage-loss benefits are generally not taxable for federal or Pennsylvania income tax. Social Security offsets and other benefits can affect take-home amounts; ask us about your specific situation.
▸ Can I sue someone else besides workers’ comp for my injury?
Sometimes, yes. If a third party (not your employer/co-worker) caused your injury — for example a driver, property owner, or defective product — you may have a separate negligence claim. We coordinate third-party claims with your comp case to maximize your total recovery.
▸ Can I be fired for filing a workers’ compensation claim?
Retaliation for filing a claim is unlawful. Your employment status and your benefit entitlement are related but separate legal issues. If you suspect retaliation, contact us immediately.
▸ Can surveillance or social media hurt my case?
Yes. Insurers use investigators and monitor public posts. Keep accounts private, avoid posting about activities, and follow your doctor’s restrictions at all times.
▸ How can a workers’ compensation lawyer help me?
Insurers have adjusters, defense lawyers, and paid doctors working to limit your benefits. Our job is to fight back.
- Audit your wage rate and injury description for accuracy
- Fight petitions and biased IME opinions
- Negotiate fair settlements when it is in your best interest
Every comp attorney here is a Certified Workers’ Compensation Specialist with decades of experience.
At Schmidt, Kirifides, Rassias & Rio, our mission is to achieve the most favorable outcome for you. Some lawyers treat cases like “just another file.” We do not. We know the financial, emotional, and family stress that comes with a work injury. Every attorney here is a Certified Workers’ Compensation Specialist with decades of experience. Insurers know which firms fight and which fold. We fight.
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