All employees should understand their rights when it comes to workers’ compensation and injuries at work because accidents can happen anywhere, at any time, no matter what your occupation is. Here is a quick breakdown to the law in Pennsylvania.
The state of Pennsylvania defines workers’ compensation as a state-mandated, no fault insurance program that provides benefits to employees who suffer job-related injuries and illnesses at work and while performing work-related duties. In general, no matter who is at fault (the employer, the employee, a coworker, a customer, even a stranger) workers’ compensation ensures that claims are paid to workers with workplace injuries that are severe enough to require medical treatment and/or prevent the worker from returning to work, either temporarily or permanently.
Types of Disabilities
Simply put, Pennsylvania divides disability into two buckets: Temporary Total Disability and Temporary Partial Disability. Disability is a term of art and means that you are suffering a wage loss. Temporary Total Disability means that you have no earnings while Temporary Partial Disability generally means you have some earnings. Another difference between these two categories is that Temporary Total Disability can last forever but Temporary Partial Disability has a 500-week time limit.
Types of Benefits Paid
Wage Loss Benefits
Weekly wage loss benefits are equal to two-thirds of the employee’s average weekly wage. Traditionally, employees suffering from Temporary Partial Disability can go back to work but not at the same capacity as pre-injury. In these cases, the compensation rate is two-thirds of the difference between the employee’s average weekly wage and the average weekly wage of the employee following his or her return to work. This benefit status is available for a maximum of 500 weeks.
In the case of Temporary Total Disability benefits, these cases can be reviewed in what is called an impairment rating evaluation. After 104 weeks of Temporary Total Disability status, an employer or insurer can require a medical examination in order to determine if the employee is at least 35 percent impaired based on his or her work injury according to American Medical Association standards. If the 35 percent threshold is not met, the employee’s status can change to partial disability. This doesn’t change your weekly benefit but it puts the time limit restriction into effect. This can be used as a tool for an employer or insurer to decrease their exposure to future benefits.
Reasonable, necessary and causally-related medical expenses associated with a workplace injury are covered under the medical expenses provision of the law. This also includes any alterations to a a home or automobile necessary to accommodate an injured worker.
Specific Loss Benefits
If the injury involved a loss of a body part, vision or hearing loss, or disfigurement on the head, face, or neck, the injured worker is eligible for specific loss benefits. This benefit is equal to a Temporary Total Disability benefit for a specific time and period of healing regardless of disability.
A widow and/or dependents are eligible for death benefits as part of workers’ compensation coverage. Benefits are paid until a spouse remarries and until dependents reach 18 years of age, unless they attend a full-time accredited school, in which case the benefit ends when they turn 23. In some cases dependent benefits can extend beyond age 25.
Even if you think you’re able to handle a situation on your own, it’s important to understand that the law gets complicated. A workers’ compensation attorney fights to ensure that the rights of the injured worker are maximized. For instance, one of the first things an attorney will do is make sure that the average weekly wage is properly calculated to ensure that the benefit rate is accurate (you can read more about calculating the benefits). Similarly, the attorney will review the medical records and make sure that the description of injury is properly recognized. This can make a significant difference in whether medical treatment is available for your injury. Ultimately, if you rely upon the insurance company and your employer to advise you regarding your benefits, you are essentially letting the mouse guard the cheese. Having an advocate on your side is critical to ensuring that you receive all of the benefits that you are entitled to.