What are the types of Workers’ Compensation benefits?
- Medical Care Benefits – Simply put, these benefits allow for the payment of reasonable, necessary, and related medical expenses, including surgical and medical services rendered by a physician or other health care provider, as well as the cost of relevant medicine, hospital stays, physical therapy, orthopedic appliances, and prostheses.
- Wage Loss Benefits – You can receive these benefits if you are either totally disabled to the point of not being able to work, or if you are now earning less that you were pre-injury due to partial disability.
- Specific Loss Benefits – These types of benefits stem from permanently losing parts of your extremities, limbs, sight, or hearing, or if you suffer a permanent disfigurement to your head, face, or neck.
- Death Benefits – If you either die on the job, or following a work related illness or injury that progresses, your surviving dependents are entitled to a financial pay out; even if the injury is declared an accident
How much should I receive for lost wages?
While the answer to this question can vary depending on your situation, Workers’ Compensation wage-loss benefits are typically equal to approximately two-thirds of your average weekly wage.
Can I file a lawsuit for my injury against my employer?
No. Workers compensation fully protects employers against lawsuits from their employees. However, if a third party was responsible for the accident, you may file a separate lawsuit.
Can I get a second opinion if my first doctor clears me to return to work?
Yes – You always have the right to obtain a “second opinion” from another doctor, including your own healthcare provider.
Do I have a choice of doctor?
If your employer accepts your claim and has posted a list of six or more physicians in your place of employment, then you must choose one of those physicians for your initial treatment provided you have signed an acknowledgment of these obligations before and after the work accident. You are required to continue treatment with that physician or another on the list for a period of 90 days after the accident. After the 90 days, or if your employer has not posted a list or has posted an improper list, or if you have not acknowledged in writing your obligation to treat with a panel provider, or if your claim is denied, you may seek treatment with any physician you choose.
What is Total Disability Benefits Status?
“Total Disability” benefits status applies to injured workers for a period during which they are considered completely unable to work. If you are considered totally disabled and out of work for more than 104 weeks, and have received “maximum medical improvement”, your employer or its insurance company can require that you attend a medical examination to determine if the condition of your injury has left you at least 50% impaired according to American Medical Association standards. This examination is referred to as an impairment rating evaluation (IRE). If your condition does not meet the 50% threshold, your status can change to “partial disability”.
What is Partial Disability Benefits Status?
“Partial Disability” benefit status applies if you return to work earning less than your time of injury wage, or you have been determined less than 50% impaired during an IRE. Partial disability benefits are paid for a maximum of 500 weeks. While on partial disability status, if you obtain a determination of impairment equal to or greater than 50% from a qualified impairment rating physician, or if your condition worsens where total disability has again occurred, you may file a Petition for Reinstatement to total disability status.
Can I lose my Wage-Loss Benefits?
According to the Pennsylvania Workers Compensation Act, you can lose your benefits as the result of any of the following three reasons:
- Your employer or its insurance carrier denies your claim and they notify you that they are terminating any temporary compensation they have been paying you during the 90 days following your injury;
- A Termination Petition is filed, and after the presentation of evidence, a Workers’ Compensation Judge orders that your benefits be terminated;
- You retired from employment and the insurance company alleges you withdrew from the workforce.
What are the Time Limits for a Workers’ Compensation claim?
You must give notice of your work-related injury no later than 120 days after the accident. In turn, the employer has 21 days from the date of notice of an injury, illness, or accident to accept or deny the claim. Please note, that the employer can start paying out temporary compensation benefits within those 21 days, but reserve the right to deny the claim within an additional 90 days.
Can I file a petition if my claim is denied?
Yes- If your request for Workers’ Compensation benefits is denied, you can file a Claim Petition within three years from the date of injury.