Workers Compensation 101
What benefits are available?
Indemnity benefits: These are the wage compensation benefits received when an injured worker is unable to perform his job duties. These are generally two-thirds of the gross average weekly wage being earned at the time of the injury. The percentage can be slightly higher or lower depending on the income, but most cases are around the two-thirds number. There is also a cap to these benefits that increases annually based on the state-wide average weekly wage. It should also be noted that there are total and partial benefits available under the Pennsylvania Workers’ Compensation Act. Medical benefits: An injured worker is entitled to have all medical bills related to the work injury, paid for directly by the employer or its insurer. Until an employer issues a formal denial of your claim, you should insist on the medical bills being paid by the employer. Having those bills paid by your health insurer can cause problems down the road. In order to maintain eligibility for these medical benefits you must treat with a panel physician for the first 90 days.Specific loss benefits: An employee who loses the use of an appendage, an eye, or hearing as a result of a work injury or working conditions, is entitled to benefits specifically set out in the Pennsylvania Workers’ Compensation Act. This includes both actual loss of the body part or damage so severe that this body part is of no functional use. These are fixed benefits which are provided regardless of actual disability.
Death benefits: In the unfortunate event of a death caused by a work injury, that employees’ surviving dependents may be eligible for compensation based on the deceased’s wages at the time of his death. There is also a funeral benefit of $3,000 available to the survivors.
What qualifies as an injury?
With few exceptions, any injury occurring on the job may qualify that employee for workers compensation benefits. There is little confusion about the typical traumatic injuries where there is a very clear relationship between the incident and the resultant injury. An example would be a leg fracture from a fall at work. However, there are other injuries which qualify that are not as clear. For instance, an aggravation of a pre-existing injury is a new injury under the Act, even though the preexisting condition occurred outside of your current employment. Other injuries which qualify under the Act include hearing loss from occupational exposure, asbestos exposure, scars to the neck and head, and pathologies from exposure to toxic chemicals in the workplace. It is very important to put your employer on notice, as soon as you suspect that an injury or disease may be work related.
What are your duties in the event of an injury?
An injured worker has an affirmative duty to advise his employer of any work related injury or disease within 120 days from the date of its discovery. This notice should be in writing and presented to the immediate supervisor of the injured worker. The injured worker should keep a copy of the notice for his records.An injured worker then has the obligation to treat with a panel doctor from the list of doctors provided by the employer. The worker must treat with that physician for the first 90 days or he loses his right to future medical benefits under the Act. After that 90 day period, the injured worker can treat with any doctor of their choice.Periodically, the injured worker may be required to complete forms as to his current medical condition and state of employment. Finally, the injured worker may be required to submit to an examination every six months during his period of disability.
