Workers' Comp Laws in Pennsylvania

If you were hurt on the job in Pennsylvania, the workers' compensation system is designed to pay for your medical care and, if you cannot work, replace part of your lost wages — without regard to who was at fault. This is a benefit you and your employer already paid for. But deadlines drive this system, and missing one can cost you your claim. Here is what to do first, and what to expect.

Deadlines first — read this part

• Tell your employer within 21 days. Under the Bureau of Workers' Compensation's own guidance, unless your employer already knows about the injury, you must give notice within 21 days of the injury to receive benefits retroactive to the injury date. Give notice later than that, and no compensation is due until notice is given.
• Absolute outside limit: 120 days. Notice must be given no later than 120 days after the injury for compensation to be allowed at all. Notice given after 120 days may cost you your benefits entirely.
• But those clocks may not start on the day you got hurt. Section 311 of the Act (77 P.S. § 631) says that “in cases of injury resulting from ionizing radiation or any other cause in which the nature of the injury or its relationship to the employment is not known to the employe, the time for giving notice shall not begin to run until the employe knows, or by the exercise of reasonable diligence should know, of the existence of the injury and its possible relationship to his employment.” So for a condition that built up over time or that nobody connected to your job until later — a repetitive-strain injury, a back condition, a latent illness — the 21 and 120 days can run from the day you learned (or should have learned) that the condition exists and may be work-related. Do not assume you are too late. Report now, and ask about this rule.
• Occupational disease: the clock runs from disability, not exposure. Section 311 ends: “The term ‘injury’ in this section means, in cases of occupational disease, disability resulting from occupational disease.” If you have a disease from exposure years ago, notice is measured from when the disease disabled you — not from when you were exposed.
• Three years to file a claim petition — but payments restart that clock. If your employer or its insurer denies your request for benefits, you generally have three years from the date of injury to file a claim petition. Under Section 315 (77 P.S. § 602), however, “where… payments of compensation have been made in any case, said limitations shall not take effect until the expiration of three years from the time of the making of the most recent payment.” If you were paid compensation and it later stopped, your three years runs from your most recent payment.
• Uninsured employer: 45 days. If your employer turns out to have no coverage, there is a separate, much shorter deadline to notify the Uninsured Employer Guaranty Fund — see below.
• 20 calendar days to appeal a judge's decision. An appeal from a workers' compensation judge to the Workers' Compensation Appeal Board must be filed within 20 calendar days of the decision's circulation date. If you miss it for a good reason, the Board may still extend the time “upon cause shown” — ask.

Do not wait to see whether you feel better before reporting. The Bureau's own advice to injured workers is that prompt reporting is the key.

What to do first

1. Report the injury to your employer or supervisor immediately, in writing if you can. Tell them you were injured in the course of employment, and give the date and place of the injury. The Bureau warns that failing to notify your employer can delay or defeat your benefits.
2. Get medical care. If it is an emergency, go to the ER or urgent care and deal with paperwork afterward. For non-emergency care, read the "who picks your doctor" section below before you choose a provider — Pennsylvania has a specific rule that can affect whether your treatment gets paid for.
3. Ask your employer for the claim paperwork and the name of its workers' compensation insurance carrier. Keep a copy of everything you sign or receive.
4. Write down what happened — date, time, place, how it happened, and who saw it — while it is fresh.

Pennsylvania's workers' compensation agency

The system is run by the Bureau of Workers' Compensation, part of the Pennsylvania Department of Labor & Industry. The Bureau administers the Workers' Compensation Act, and its Office of Adjudication assigns petitions to workers' compensation judges who decide disputed cases.

The Bureau's Claims Information Helpline is 800-482-2383 (toll-free in Pennsylvania) or 717-772-4447 (local and outside Pennsylvania), Monday through Friday, 7:30 a.m. to 4:30 p.m. PA Relay is 7-1-1. Helpline staff answer general questions about the process; they do not represent you and do not give legal advice.

Official sources: Department of Labor & Industry — Workers' Compensation and the Bureau's injured-worker booklet, Workers' Compensation and the Injured Worker (LIBC-100).

Who is covered in Pennsylvania

Nearly every Pennsylvania worker is covered. There is no employee-count threshold: employers must provide coverage for all of their employees, including seasonal and part-time workers, and nonprofit corporations, unincorporated businesses, and employers with only one employee must comply with the Act.

Pennsylvania is not a monopolistic state-fund state. Benefits are paid by private insurance carriers (including third-party administrators), by the State Workers' Insurance Fund (a state-run carrier that competes with private insurers), or by employers who qualify to self-insure.

Some workers are covered by other compensation laws instead, including federal civilian employees, railroad workers, longshoremen, and shipyard and harbor workers. Others who may not be covered under Pennsylvania's Act include volunteer workers, agricultural laborers, casual employees, domestics, and employees granted a personal religious exemption. Certain corporate executive officers may elect exemption from the Act. The exact limits on these categories are technical — if you are in one of them, confirm your status with the Bureau rather than assuming you are out.

If your employer has no coverage — a 45-day deadline applies: if you learn that your employer is neither insured nor self-insured, you may be eligible for benefits from the Uninsured Employer Guaranty Fund. This Fund has its own short deadline, separate from the three-year claim-petition deadline described below. Under Section 1603(b) of the Act and 34 Pa. Code § 123.802(a), you must notify the Fund within 45 days from the date you knew your employer was uninsured. Notice is given on form LIBC-551, Notice of Claim Against Uninsured Employer (it can also be filed electronically through WCAIS). No compensation is paid from the Fund until that notice is given, and under 34 Pa. Code § 123.804 you cannot file a claim petition against the Fund until at least 21 days after the notice. Do not let this one sit — send the notice, then call the Bureau's helpline with questions.

The deadline to file a claim — the three-year rule

If your employer or its insurance carrier denies your request for benefits, you generally have three years from the date of injury to file a claim petition. The petition goes to the Bureau's Office of Adjudication, which assigns it to a workers' compensation judge.

Important exception — if any compensation was ever paid, the three years runs from the last payment. Section 315 of the Act (77 P.S. § 602) provides that “where… payments of compensation have been made in any case, said limitations shall not take effect until the expiration of three years from the time of the making of the most recent payment prior to date of filing such petition.” So if the insurer paid you for two years and then cut you off, you are not automatically out of time — your clock is measured from that most recent compensation payment, not from the injury. (A payment made under a non-occupational sickness or disability plan and identified as not workers' compensation does not count for this purpose.) Section 315 also provides that for an occupational disease, “injury” means the disability resulting from the disease — so that clock, too, is measured from disability rather than from exposure — and it contains a discovery rule for injuries from ionizing radiation whose nature or work relationship was not known to the worker.

Some related time limits the Bureau publishes:

• Occupational disease. Your disability must occur within 300 weeks of your last employment in the occupation where you were exposed to the hazard, and a petition must be filed no later than three years from the date of injury or disability. For certain lung diseases, you must have worked in an occupation with a silica, coal, or asbestos hazard for at least two years in Pennsylvania during the 10 years before your disability.
• Benefits terminated. You may file a petition to reinstate benefits within three years after the date of your most recent workers' compensation check.
• Benefits suspended. A reinstatement petition must be filed within 500 weeks from the date of the suspension.

The Bureau cautions that failing to file a petition on time may forfeit your right to benefits. If your injury developed gradually, or you only later realized a condition was work-related, how these clocks apply to you can get technical fast — call the Bureau's helpline or a legal aid office well before any deadline you think might apply, rather than guessing.

Medical care: who picks your doctor

This is the most misunderstood part of Pennsylvania's system.

You are free to choose your own health care provider — unless your employer has accepted your claim and has posted in your workplace a list of six or more physicians or health care providers. If a valid list is posted, you must visit a provider on the list for initial treatment, and continue treating with that provider (or another one on the list) for 90 days following your first visit. You may pick any provider on the list; your employer may not require or direct you to a specific one.

If you go outside the list during that 90-day period, your employer or its insurer may refuse to pay for that treatment. After the 90 days — and in any situation where your employer has no posted list or an improper one — you may treat with any provider you select. You must tell your employer which provider you have chosen. Ask your employer whether a list is posted before your first appointment.

Two more rules worth knowing: if a listed provider recommends invasive surgery, you are entitled to a second opinion paid for by your employer or its insurer (treatment resulting from that second opinion must be provided by a listed provider for 90 days). And once you are receiving benefits, the employer or insurer may ask you to be examined by a doctor of its choosing; if you refuse, it can ask a judge to order the examination, and failing to attend can suspend your benefits.

Medical bills for a work injury are paid at the state fee schedule rate, and the provider cannot balance-bill you the difference. (Treatment sought outside Pennsylvania may carry a balance-billing risk — discuss it with the provider first.)

Wage-replacement benefits

Wage-loss benefits are approximately two-thirds of your average weekly wage, up to a weekly maximum. That maximum is a dollar figure that the state adjusts every year — do not rely on any figure you see quoted somewhere; check the Bureau's current published rates. There is a minimum compensation rate too: the lower of 90 percent of your own average weekly wage or 50 percent of the statewide average weekly wage. The law does not provide a cost-of-living increase, and benefits can be offset for things like 50 percent of Social Security retirement benefits, the employer-paid portion of a pension, severance, unemployment compensation, or other earnings.

The waiting period

You must be disabled more than seven calendar days (weekends included) before wage-loss payments are payable. The statute measures that week from when disability begins, not from the injury date: Section 306(e) of the Act (77 P.S. § 514) says “no compensation shall be allowed for the first seven days after disability begins,” and “if the period of disability lasts fourteen days or more, the employe shall also receive compensation for the first seven days of disability.” That matters in the common case where you are hurt, keep working, and only go out of work later — the waiting period starts when you actually become disabled. So benefits for lost time are payable beginning on the eighth day of disability, and once you have been off work 14 days, you receive retroactive payment for that first seven-day stretch. Medical benefits are different: they are payable from the first day of the injury, even if you lose no time from work.

If you reported promptly, missed more than seven days, and the carrier accepted your claim, the Bureau says you should receive your first compensation check within 21 days of your absence from work.

Temporary compensation

An employer or insurer may pay temporary compensation for up to 90 days without accepting liability. These payments can stop at any time. If they tell you they are stopping temporary compensation past 90 days, or they deny your claim, you have the right to file a claim petition.

Permanent and partial disability

Total disability status applies while you are considered totally disabled and unable to work. After 104 weeks of total disability status, the employer or insurer can require a medical examination to determine whether you are at least 35 percent impaired from your work injury, measured under American Medical Association standards. If the 35 percent threshold is not met, your status can change to partial disability.

Partial disability status is payable for a maximum of 500 weeks. It also applies if you return to work at a lower-paying job within your restrictions, or you are found not totally disabled. If, while on partial status, a qualified impairment-rating physician determines your impairment is 35 percent or greater, you may petition to be reinstated to total disability status.

Specific loss benefits are separate: if you permanently lose the use of all or part of a thumb, finger, hand, arm, leg, foot, toe, sight, or hearing, or have a serious and permanent disfigurement of the head, face, or neck, you may be entitled to a specific loss award.

The medical evidence and math behind an impairment rating are complex. Get case-specific guidance before you agree to any rating result.

If your claim is denied or benefits stop

The insurer is allowed 21 days from your notice to the employer to accept your claim, deny it, or start temporary compensation. If you believe you are owed benefits you are not getting:

• Start by contacting your employer or its insurance carrier. Many problems are resolved this way.
• File a petition with the Bureau's Office of Adjudication (within the three-year deadline). Forms are available from the Bureau's website or the Claims Information Helpline at 800-482-2383. Your case is assigned to a workers' compensation judge, who holds hearings and decides it.
• Alternative dispute resolution is built into the process. Once a petition is filed, the judge will schedule mediation unless it would be futile, and the parties may also use a settlement conference. You can also request an informal conference — and if you are not represented by an attorney there, your employer is not entitled to be represented either.
• Appeal to the Workers' Compensation Appeal Board. If you disagree with the judge's decision, you have 20 calendar days (not business days) from the circulation date of the decision to file an appeal with the Board. The circulation date is printed on the front page of the decision. If the 20th day falls on a weekend or holiday, the deadline moves to the next business day — but do not plan around that cushion. Appeals may be filed electronically through the state's WCAIS system or on paper. If you miss the 20 days, do not simply give up: Section 423(a) of the Act (77 P.S. § 853) provides that “the board may, upon cause shown, extend the time provided in this article for taking such appeal or for the filing of an answer or other pleading.” You have to ask, and you have to show a reason — so act immediately.
• Further appeal — 30 days. An appeal from the Board goes to the Commonwealth Court of Pennsylvania. The Workers' Compensation Appeal Board states that any aggrieved party has 30 days from the date of the Board's decision to appeal to Commonwealth Court.

Getting help in Pennsylvania

• Bureau of Workers' Compensation Claims Information Helpline: 800-482-2383 (toll-free in PA) or 717-772-4447, Monday–Friday, 7:30 a.m. to 4:30 p.m.; PA Relay 7-1-1. General questions about the process, forms, and status.
• Free interpreters and accommodations: if you need a sign language interpreter, a non-English interpreter, or an accommodation for a hearing, you can request one at no cost through the Bureau.
• Legal aid: free or low-cost civil legal help may be available to eligible workers through Pennsylvania's legal aid programs.
• Pennsylvania Bar Association Lawyer Referral Service: 800-692-7375. You may represent yourself in a workers' compensation proceeding, but the Bureau notes that the litigation is complex and the employer's side will usually have an experienced attorney. If you hire one, discuss fees and costs up front — the fee agreement must be approved by a workers' compensation judge or the Workers' Compensation Appeal Board.

One caution from the Bureau: workers' compensation forms and reports must be completed honestly — insurance fraud is a crime. Report what actually happened, and report it promptly.

This is general legal information about Pennsylvania's workers' compensation system, not legal advice about your situation. Deadlines and eligibility can turn on facts unique to your case. When in doubt, confirm with the Bureau of Workers' Compensation or a legal aid office before a deadline passes.