Pennsylvania Workers' Compensation Laws

Some people get hurt during their course of employment. Most workplace injuries are minor, and the employee only misses a few days or weeks of work. More serious accidents can require significant medical treatment. Injured workers can file a workers’ compensation claim.

If your employer and their workers’ compensation insurance carrier approve your claim, they’ll cover your medical expenses and provide replacement wages. You’ll continue to receive workers’ compensation benefits until you either recover or reach “maximum medical improvement.”

This article explains how workers’ compensation works in Pennsylvania. We’ll also discuss the types of benefits you can receive and what happens when your workers’ comp claim ends.

If you’ve suffered a workplace accident or occupational illness and your employer has denied your workers’ comp claim, consider getting legal advice from an experienced Pennsylvania workers’ compensation lawyer. They’ll review your case, explain your specific loss benefits, and ensure you make all required filings within the time limits.

Who Is Eligible for Workers’ Compensation in Pennsylvania?

Almost all workers are eligible for workers’ compensation in Pennsylvania. The Pennsylvania Workers’ Compensation Act requires that all employers with at least one employee maintain workers’ compensation coverage. This applies to companies with full-time, part-time, and even seasonal workers.

There are exceptions to this rule. Certain categories of workers are not entitled to workers’ comp benefits. These include the following:

• Sole proprietors
• Partners in a business
• Federal employees
• Railroad employees
• Domestic workers
• Most agricultural workers
• Independent contractors/consultants

If a business owner fails to carry the required insurance coverage, they may face fines, penalties, and even stop-work orders.

When Should You File a Workers’ Compensation Claim?

Workers’ compensation is meant to help cover medical bills and provide wage loss benefits for employees who get hurt on the job. To qualify for workers’ compensation benefits, you must demonstrate that your injuries are work-related. If your accident occurred at work and on company property, your workers’ compensation claim has a good chance of being approved.

Workers’ compensation means employees shouldn’t have to pay out of pocket for medical costs related to a workplace accident or illness. It also protects them from losing wages for any time lost because of the accident.

Not all injuries qualify for a workers’ comp claim. You’re likely to be denied workers’ comp benefits for any claims that include any of these reasons:

• Your accident or injuries took place on personal time
• You were under the influence of drugs or alcohol at the time of the accident, and this impairment is what caused your injuries
• You have a pre-existing condition that is the underlying cause of your injuries
• You were not on the clock at the time and date of injury
• Witnesses can confirm that your accident was not on company property

If you were working within the scope of your employment at the time of your workplace injury, the injury occurred on company time and on company property, and you were not under the influence of any substance, you should file a workers’ comp claim.

If you aren’t sure whether it’s in your best interest to file a claim, talk to a Pennsylvania workers’ comp attorney. They’ll review your situation and advise you on how best to proceed. If you file a claim and the Pennsylvania Bureau of Workers’ Compensation denies it, you can appeal to the Pennsylvania Workers’ Compensation Appeal Board.

Filing a Workers’ Compensation Claim in Pennsylvania

You must file any workers’ compensation claim before the time limits expire. If you don’t, your employer or their insurance company may deny your claim. Unless you have an additional healthcare provider, you may end up paying your medical costs yourself.

The workers’ compensation claim process in Pennsylvania is as follows:

• Seek immediate medical attention for any injuries you suffer during a workplace accident. This can be from company medical personnel or an emergency room/urgent care.
• Once you receive emergency medical care, report your workplace injuries or illness to your manager or Human Resources department. You must do this within 21 calendar days of your accident to qualify for workers’ comp benefits from the start of the injury. If you give notice between 22 and 120 days, your compensation starts on the date you gave notice.
• When you report your accident to your employer, it will file a “First Notice of Injury.” They are required to provide you with a copy of the form.
• Your employer may choose to deny your workers’ compensation claim. If so, it must issue a “Notice of Denial.”
• If your employer denies your claim, you can file a Claim Petition. A Workers’ Compensation judge will hold a hearing. You can appeal their denial to the Workers’ Compensation Appeal Board.
• You have three years from the date of your injury (or the date your employer files its “First Notice of Injury” form) to file your workers’ compensation claim with the Pennsylvania Bureau of Workers’ Compensation. It’s better to file as soon as possible.

The claims process can be overwhelming, especially if you’re dealing with a serious injury or illness. Ideally, your employer’s Pennsylvania workers’ compensation insurance will pay your claim. If your employer was reckless or intentionally caused your injuries, you may be able to file a claim under their employers’ liability insurance policy. An experienced Pennsylvania personal injury attorney can help you with either process.

What Benefits Are Available Under Workers’ Compensation in Pennsylvania?

If the insurance company approves your workers’ comp claim, you’ll receive several types of benefits. Your employer’s insurance carrier will cover your medical care. As long as the medical treatment is directly related to your workplace accident and is reasonable and necessary, there shouldn’t be an issue.

In addition to medical care, you’ll also receive replacement wages. If you miss more than three days of work, you can collect compensation for your lost wages. This is capped at 2/3rds of your average weekly wages. You may also be entitled to disability benefits, should your workplace accident leave you with a total or partial disability.

Medical Benefits

The primary reason employers carry workers’ comp insurance is to cover injured employees’ medical bills. As long as your medical treatment is reasonable and necessary, workers’ comp should cover it. This coverage will continue until you return to work or reach maximum medical improvement.

Some of the medical care covered by workers’ compensation includes:

• Emergency room visit
• Ambulance ride
• Hospitalization
• Prescription medications
• Physical therapy
• Vocational rehabilitation
• Chiropractic care (in some cases)
• Medical devices/medical equipment

If the insurance company refuses treatment or refuses to pay your medical bills, let your Pennsylvania workers’ comp lawyer know right away.

Replacement Wages

Workers’ comp also covers lost wages. The amount of your weekly benefits depends on your income. You’ll receive 67% of your average weekly wages (AWW).

To calculate your AWW, divide the year into four 13-week quarters. Use the average of the highest three gross wages earned among those quarters. To determine the weekly benefit rate, you multiply the AWW by 0.67. This will be your weekly benefit rate.

Pennsylvania law caps the amount you can receive through workers’ comp each week. The maximum compensation rate for 2026 is $1,394 per week. Even if your weekly compensation payments would be much higher, this is the most you can receive in any given week.

Death Benefits

Some workplace accidents or occupational diseases are so serious that the worker dies as a result of their injuries. If this happens, the employee’s spouse and/or dependents may be entitled to the weekly benefits their loved one would have received had they survived. In addition to weekly benefits, the decedent’s family will also receive reimbursement for burial or funeral expenses.

Who Decides When You Return To Work?

Pennsylvania employers must pay their employees weekly disability benefits until they are ready to return to work. In some cases, the employee can never return to work full-time or even part-time. In these cases, the employee may begin receiving permanent disability benefits.

In most cases, the employee recovers enough to go back to work. They can start after approval, based on the employee’s workers’ comp doctor’s opinion that they’ve reached maximum medical improvement (MMI). MMI occurs when your workers’ compensation doctor determines that further treatment will not improve your condition.

If you disagree with your doctor’s assessment and don’t think you’re ready to go back to work, you can ask for a second opinion. Your attorney can arrange an Independent Medical Examination (IME). An IME is when a doctor other than the one who has been treating you throughout your workers’ compensation claim examines you to determine whether you’re ready to return to work. This may be at your own expense. If the IME shows you need further treatment or are permanently and totally disabled, a Pennsylvania personal injury lawyer can challenge the insurance company’s findings.

What if You’re Permanently Disabled After Your Workplace Accident?

If you end up permanently disabled (partial or total) after your workplace accident, you may be entitled to significant compensation. It depends on the nature of your injury and which body part is involved.

Pennsylvania categorizes permanent disability awards based on the body part affected. For example, a foot injury will be worth a lot less than a back or neck injury. Your total disability benefits will depend on the specific amount allocated to your injured body part.

When determining your permanent award, the insurance company will look to see how many weeks your body part is worth. It then multiplies that number by your percentage of disability. Finally, it will multiply that number by your weekly benefit rate. In most workers’ compensation cases, the claimant (and their attorney) negotiates a lump-sum settlement rather than waiting and collecting weekly payments for months or years.

What if the Insurance Company Denies Your Claim?

Most workers’ comp claims are approved without issue. If the insurance company denies your claim, you have the right to file an appeal. The appeals process can be intimidating, and you only get one chance to get it right. Consider consulting a Pennsylvania workers’ compensation attorney if you’re facing an appeal. If you don’t follow the proper steps, the Pennsylvania Bureau of Workers’ Compensation will deny your appeal, and you’ll lose your opportunity to receive benefits.

For an appeal, you’ll file a formal Claim Petition with the Bureau of Workers’ Compensation within the three-year statute of limitations. Before you begin filling out your petition, make sure you know the reason for denial. This information is clearly stated on your “Notice of Denial.”

Disclaimer: State laws are subject to change due to new legislation, higher court rulings, and other means. While we strive to provide the most current information, consult a Pennsylvania workers’ compensation attorney or conduct further legal research to verify your state laws.

Seek Legal Advice Regarding Your Pennsylvania Workers’ Compensation Claim

If you suffer an injury at work and aren’t sure how to file a workers’ compensation claim, contact a local workers’ comp attorney. The Pennsylvania workers’ compensation system and claims process can be complex and overwhelming, especially while you’re recovering from a work-related injury. If your claim is denied, you won’t receive reimbursement for out-of-pocket medical bills or replacement wages.

An experienced Pennsylvania workers’ compensation attorney will review your claim and, if warranted, help you file an appeal. They will also fight to get you the benefits you deserve.