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What To Know About Workers' Compensation In Pennsylvania

Last updated: April 9, 2023

Workers' compensation, also known as "workers' comp," is a type of coverage that helps companies cover expenses for people who have been injured or have fallen ill while on the job.

Though workers' compensation benefits are available throughout the country, some governing rules differ in each state. To learn about workers’ compensation PA, find out what it is as a whole, what it covers, how to file it, and more.

Workers' Compensation PA In A Nutshell

When an employee gets hurt or sick on the job, workers' compensation helps pay for medical bills and lost wages. This coverage also covers employers for the liabilities they have to shoulder due to the expenses involved in these injuries.

In Pennsylvania, benefits will be provided once a "compensable injury" is established. To qualify, it must meet these criteria:

  • Injury must have happened to an employee, not an independent contractor, buyer, or supplier
  • Injury must have harmed the employee, leading to medical bills and lost wages
  • Injury must have occurred during employment and must be related to work. It may occur on or off the work premises as long as the employee is acting for the employer's business

What Workers' Compensation PA Covers

Though each workers' compensation case is unique, the insurance policy covers work-related injury scenarios. Most of the time, the policy will pay the cost of all medical providers and two-thirds of the total income lost due to the employee being unable to work.

Ultimately, the primary Pennsylvania workers' compensation benefits are:

Medical Benefits

Payment for medical expenses includes the costs of medicine, medical supplies, hospital treatments and services, rehabilitation, prostheses, surgical and medical services, and orthopedic appliances.

Disability Benefits 

Worker's compensation will also cover an injured employee who has lost the use of an arm, foot, finger, hand, leg, or toe, their sight, their heating, or who has suffered a disfigurement on the face, head, or neck.

Wage Loss Benefits

Worker's compensation will compensate an injured worker for the amount they lose as a result of being totally disabled and unable to work or being partially disabled and earning less than they did before the injury.

Death Benefits

Should an injury lead to an employee's death, the surviving dependents may be entitled to receive death benefits.

Is Workers' Compensation Coverage Required In Pennsylvania?

Workers' Compensation Coverage PA

Businesses in the Commonwealth of Pennsylvania with at least one employee must provide workers' compensation insurance. However, there are things to keep in mind and exceptions to consider.

To start, all individuals that you consider employees, even if they are family members or work part-time, must be covered under your company's policy.

If you are the sole proprietor of a business, you are not required to have one. However, if your company belongs to a high-risk industry, you should consider it for your protection.

For businesses with larger structures, you may consider exemptions. However, you'll have to fill out an application form, complete other requirements, and settle the fee to complete the workers' compensation exemption.

If your company works with casual workers, you must work with your lawyer to define the gray area. The PA Department of Labor and Industry has no distinct definition of a casual worker, so ensure you get the legal guidance to follow state law.

What Happens If A Business Does Not Enroll In A Workers' Comp Policy?

If your small business operates on a tight budget, it might be tempting to skip other coverage to avoid extra costs. However, this is something required by law, and if you decide not to purchase workers’ compensation PA coverage, you will have to expect the following consequences:

  1. If a company is non-compliant with workers' compensation requirements, they could face a fine of $2,500, a year in prison, or both. 
  2. In some cases, failing to provide workers' comp may lead to a felony, $15,000 fines, and up to seven years in prison.
  3. Not having a workers' comp policy also means your company has to take money out of your pocket if an employee is injured. Depending on the type of injury, the settlement may be more expensive than a premium.
  4. If an employee sues you for damages due to their condition, you face the risk of possibly going bankrupt due to a lawsuit.

How To File A Workers' Compensation Claim In Pennsylvania

If an employee encounters a work injury, there are necessary steps to ensure safety and recovery. It would help if you started filing the workers' compensation claim accurately. Here are some steps to follow:

  1. Before anything else, call 911 and ensure you provide the correct information to help the employee receive the proper medical care. If the situation is different, like carpal tunnel syndrome, you must still work with the medical care provider.
  2. After the medical treatment, make sure you file the claim on time. In Pennsylvania, there are timeframes to follow. In particular, employees have 120 days to inform their employers of their occupational disease or injury. The report must include the injury date, the body parts affected, and the incident's timeline.
  3. Once the information about the injury is documented, it's time to contact the insurance carrier to file the workers' compensation claim.
  4. Should the employee need time off work to recover, make sure they submit the Employer’s Report of Occupational Injury or Disease to the Bureau of Workers’ Compensation.
  5. The insurers may require additional paperwork like the Workers’ Compensation Medical Form and the medical evidence as proof of the damages, so make sure you can provide them.

Know Your Workers' Compensation PA Benefits

Workers' compensation coverage ensures Pennsylvania employees will be safe from the consequences of injuries on the job. If you want to learn more about the benefits it can bring, you can contact the PA Bureau of Workers’ Compensation, work with a lawyer, or book an appointment with an insurance agent.

For more information on worker's compensation, check out the Disability Help guide to qualifying for workers' compensation benefits.

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Zoey Appleton
Zoey has worked with Cheri for years and has been creating the best articles not only for Disability Help but for our readers. Her job hits close to home for she has a brother with special needs. She hopes to see science and technology pave the way for a better life, with Disability Help to cover it and share it with those that need it.
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