How to File a Pennsylvania Workers’ Comp Claim

May 21, 2022 | Workers’ Compensation

How to File a Pennsylvania Workers' Comp Claim

Pennsylvania employers are required to have workers’ compensation insurance coverage in most cases. Failing to have workers’ comp coverage could result in criminal and civil penalties for an employer.

The Pennsylvania Workers’ Compensation Act governs workers’ comp claims filed within the state. Workers’ comp ensures that employees who sustain a work-related injury can receive the medical treatment they need. The law also provides other benefits to injured workers, including wage benefits. 

If you are injured on the job, it is crucial that you understand your rights. It is also essential that you understand how to file a Pennsylvania workers’ comp claim.

Steps for Filing a Workers’ Compensation Claim in Pennsylvania

Your employer should provide information for filing a workers’ comp claim. You can also view information about filing claims on the Department of Labor & Industry website.

Notify Your Employer of a Work Injury or Illness

The first step is to notify your employer you were injured at work or diagnosed with a work-related illness. You have 120 days to notify your employer of a work injury under Pennsylvania workers’ compensation laws.

However, if you file a report within 21 days after an injury, you can receive workers’ comp benefits beginning with your injury date. Otherwise, you receive workers’ comp benefits from the report date.

Seek Medical Treatment

Go to the emergency room for serious and life-threatening injuries. If your injury is non-life-threatening, the workers’ compensation insurance provider or your employer may require you to seek medical treatment from an approved provider. Check with your employer for a list of approved medical providers.

File a Formal Workers’ Compensation Claim

File your claim with the Pennsylvania Department of Labor and Industry as soon as possible to begin receiving workers’ comp benefits. 

The statute of limitations (deadline) for filing a workers’ comp claim is three years. However, it is best to seek legal advice about your claim from a workers’ compensation lawyer as soon as possible. 

The workers’ comp case generally begins when your employer files a First Report of Injury and notifies its workers’ compensation insurance provider of your claim. The insurance company has 21 days to approve or deny your workers’ comp claim. 

The insurance provider can pay workers’ comp benefits for up to 90 days while gathering information and investigating your claim. The company may stop payments and notify you of a denial of the claim at any time during those 90 days.

You have the right to appeal a denial of a workers’ compensation claim. However, you must file your appeal before the deadline for appeals expires. 

You have the right to seek legal counsel about your claim and/or an appeal. It can benefit you to hire a workers’ comp attorney as soon as you receive notice of a denial of a claim. 

Workers’ Compensation Benefits You Can Receive in Pennsylvania

Workers’ compensation does not compensate you for your pain and suffering damages. However, it provides medical and wage benefits that can help you recover from a work-related injury.

Medical Benefits

You are entitled to receive reasonable and necessary medical care for a work illness or injury. Examples of medical care that workers’ compensation should cover include:

  • Treatment in an emergency room or urgent care facility
  • Hospitalizations 
  • Surgeries 
  • Bills from physicians and other medical providers
  • Cost of diagnostic testing and lab work
  • Medical supplies, medications, and medical devices
  • Occupational, physical, and vocational therapies
  • Second opinions

In Pennsylvania, workers must seek treatment from an approved medical provider chosen by the employer or the workers’ compensation insurance provider. Your employer must give you a list of at least six medical providers. You may choose any provider on that list.

The law requires you to continue treatment with the medical provider for at least 90 days after the initial visit. If the doctor says you need surgery, you may seek a second opinion at the employer’s cost. However, you must choose a provider on the approved list for a second opinion.

After the required 90-day treatment period ends, you may seek medical care from any physician you choose. 

Wage Benefits

Workers’ compensation provides wage benefits for employees who cannot work because of a work injury or illness. However, you do not receive compensation for all lost income. 

The workers’ comp rate for loss of income equals two-thirds of your average weekly wages. However, the amount is subject to state minimum and maximum adjustments. 

Other Benefits of a Workers’ Compensation Claim

Workers may also be entitled to specific compensation for the loss of a body part or permanent, significant disfigurement. In addition, family members may also receive death benefits for a work-related fatality.

Before settling a workers’ compensation claim, you may want to talk with a lawyer about your case. The insurance company may not offer you the full value of your claim, or you could be entitled to additional compensation or benefits for a workplace accident.

If you’ve been injured in a personal injury, please contact Marzzacco Niven & Associates at the nearest location to schedule a free consultation today:

Harrisburg Law Office
945 East Park Drive, Suite 103 Harrisburg, PA 17111
(717) 231-1640

York Law Office
2550 Kingston Road, Suite 210A York, PA 17401
(717) 995-8998

Wyomissing Law Office
833 N. Park Road, Suite 103, Room A Wyomissing, PA 19610
(717) 388-2325

Chambersburg Law Office
79 St. Paul Drive, Suite 1 Chambersburg, PA 17201
(717) 388-2378

Carlisle Law Office
354 Alexander Springs Road Carlisle, PA 17015
(717) 995-8732

Carbondale Law Office
30 Lincoln Avenue, Suite 101 Carbondale, PA 18407
(717) 995-8810

Lancaster Law Office
2173 Embassy Drive, Ste 123, Lancaster Pa 17603
(717) 616-2954

Lebanon Law Office
937 Willow Street, Suite D Lebanon, PA 17042-1140
(717) 995-8963