Injured workers should report the injury to their employer immediately. You have 120 days from the date of injury to file a claim. If your employer or its insurance provider denies your workers’ compensation claim, the deadline to file a claim petition and appeal the denial is three years from the date of injury.

Claims for occupational illnesses must be filed no later than three years from the date of injury or disability. The injury or disability must occur within 300 weeks of the date of last employment where you had exposure to the hazard. 

Your employer or its insurance company is responsible for paying for reasonable and necessary medical care for work-related injuries or illnesses covered by workers’ comp.

During the first 90 days after the accident, you must seek medical care from one of the six or more physicians your employer chooses if your employer accepts your claim. Otherwise, you must pay for your medical care out of your own pocket.

If your employer does not provide a list of physicians or after 90 days, you may seek medical treatment from a physician of your choosing. You must notify your employer of the physician you choose to provide medical treatment. 

If a doctor on the employer’s list recommends invasive surgery, you have the right to seek a second opinion. The employer or insurance provider is responsible for paying for the cost of a second opinion. 

Workers’ compensation is a no-fault system. You do not need to prove negligence by your employer to receive benefits. 

Likewise, if you contributed to the cause of your injury, you may still be eligible for workers’ compensation benefits. Comparative negligence laws would not apply.

However, if you intentionally caused your injury, you cannot recover workers’ comp benefits. 

Injured workers are generally entitled to receive income benefits for lost wages caused by a work-related accident or injury. The amount of your wage-loss benefits depends on your average weekly wage. 

Lost wage benefits are equal to approximately two-thirds of your average weekly wage. However, the state imposes minimum and maximum adjustments for the benefit rate. 

For example, the maximum wage-loss benefit for injuries on or after January 1, 2022, is $1,205. If your average weekly wage is $669.43 or less, your wage-loss benefits equal 90 percent of your average weekly wage.

You must be unable to work for more than seven calendar days to receive temporary disability (wage-loss) benefits. Benefits begin on the eighth day after your injury. If you are out of work for more than 14 days, you receive retroactive benefits for the first seven missed days of work.

The amount you may receive for permanent impairments depends on the type and severity of your injury. You can receive temporary total disability benefits for 105 weeks. After that time, a doctor determines the extent of your disability.

If your impairment rating is 35% or higher, you may continue to receive total disability payments. If you can return to work at a lower-paying job, you could receive partial disability benefits for up to 500 weeks.

Injured workers who sustain physical disfigurement or loss of a specific body part may be entitled to additional benefits.

Specific loss benefits are available for permanent use of all or part of your:

• Toe
• Finger
• Hand
• Foot
• Thumb
• Leg
• Arm
• Hearing
• Vision

You may also receive specific loss benefits if you sustain permanent disfigurement to your neck, face, or head.

Most occupational diseases are covered by workers’ compensation. The illness must have been caused or aggravated by work-related conditions or job duties. Some restrictions may apply. 

The Pennsylvania workers’ compensation system covers most work-related injuries from accidents to defective machinery. However, if you intentionally hurt yourself or your injury resulted from a criminal act, your injury would not be covered by workers’ compensation Examples would include suicide and illegal drug use (in case you refuse to get a drug test).

When a worker dies because of a job-related illness or injury, the surviving spouse and dependent family members may receive death benefits. Workers’ compensation death benefits are based on the person’s relationship to the deceased worker and the worker’s average weekly wage at the time of death. The weekly amount a surviving spouse, child, or other eligible dependents may receive is subject to the maximum rate for wage-loss benefits. 

A workers’ compensation claim may be denied for many reasons. A denial does not mean that you will not receive workers’ comp benefits. Your claim may have been denied because you failed to provide all personal information requested, your Social Security Number was incorrect, or the information on the accident report was incorrect. Correcting the information may resolve the denial of the claim.

However, your employer may challenge the severity of your injury or the cause of your injury. In that case, fighting the workers’ comp denial could be challenging.

You have three years from the date of injury to file a Claim Petition for Compensation with the Bureau of Workers’ Compensation. A judge determines whether your claim is approved or denied.

You are not required to hire an injury lawyer to file an appeal. However, it is wise to have legal counsel. 

Your employer and the insurance company likely have a team of lawyers, investigators, and claims adjusters working to protect their best interests. You deserve the same level of legal representation.