So, you’ve been injured at work and you’ve filed a Pennsylvania workers’ compensation claim. You know the injury is bad, but the doctors don’t know how long it will take to recover or if you’ll be able to work the same job again once you heal. But you need to think long-term: what will your family need in a year? Two years?
And will your benefits last that long?
The first thing to understand is that your workers’ comp benefits are actually two benefits: wage loss benefits and medical expense benefits. The amount of time you’re entitled to one or the other depends on different factors.
How Long Do Workers’ Comp Medical Benefits Last in Pennsylvania?
Medical expense benefits are relatively simple: the workers’ comp insurer is obligated to pay any “reasonable, necessary, and related” medical costs involving your injury until you reach MMI, or maximum medical improvement.
MMI is the point at which you’re as healed as you’re going to get. Once the insurer finds that you’ve reached MMI, they’ll likely reduce your benefits to cover ongoing pain management costs or other palliative care. However, if you’ve suffered a lifelong injury, you may be eligible to receive workers’ comp benefits in some form for the rest of your life.
How Long Do Workers’ Comp Wage Loss Benefits Last in Pennsylvania?
How long your wage loss benefits last will depend on the kind of benefits you receive. For temporary injuries, you’ll receive 66% of your average weekly wage for 90 days. For long-term injuries (or “permanent disability”), the PA Workers’ Compensation Act entitles injured employees to at least 104 weeks (or 2 years) of wage loss benefits.
After two years have elapsed, the workers’ comp insurer is allowed to request an Impairment Rating Evaluation to determine the extent of your disability. If you’re found to be more than 50% disabled, you’ll continue receiving total disability benefits under the law. If you’re found less than 50% disabled, you’ll be entitled to partial disability benefits. The amount of benefit you’ll get won’t change, but you’ll be limited to receiving 500 additional weeks of wage loss benefits, which is roughly 9 and a half years.
So even in a situation where you have a partial disability with an impairment rating under 50%, you’ll be entitled to over 11 years of wage loss benefits total.
What Is the 90-Day Rule For Workers’ Comp in PA?
The 90-Day Rule in Pennsylvania workers' compensation law requires injured workers to receive treatment from a medical provider on the employer's approved list for the first 90 days after an injury. This rule is significant because it dictates where and from whom you can receive treatment immediately following a workplace injury.
After reporting a workplace injury, your employer will provide you with a list of at least six approved medical providers. You must choose one of these providers for your initial treatment and continue with them or another provider from the list for any related medical care for the first 90 days after your injury.
- Selection of Providers: The list must include various specialists relevant to potential workplace injuries and at least three physicians. The providers listed must be geographically accessible and offer treatment without upfront costs to the employee.
- Quality of Care: The care provided by these approved providers should meet all the required standards for medical treatment. They are supposed to offer comprehensive care for injuries typically encountered in your specific workplace.
Exceptions to the 90-Day Rule
There are exceptions where you can choose your doctor outside the approved list before the 90-day period ends:
- Emergency Situations: If the injury requires emergency medical treatment, you can go to the nearest emergency facility, regardless of whether it is on the approved list.
- Specialist Referrals: If the approved providers determine that a specialist is necessary and no such specialist is on the list, you may go outside the list to receive appropriate care.
- Inadequate List: If your employer fails to provide a list or the list does not meet the legal requirements (e.g., not enough providers or specialties), you may choose your provider.
What Happens After 90 Days?
After the initial 90 days, you have the freedom to seek treatment from any healthcare provider, not just those on the employer's list. However, it’s essential to notify your employer about the change in your medical provider to ensure the continuation of your benefits and proper handling of your workers’ comp claims.
This rule is designed to control the cost of workers' compensation insurance for employers while also ensuring that injured workers receive prompt and professional medical care. However, it can impact your ability to choose your preferred medical provider during the critical early phase of treatment.
What Is the Maximum Workers’ Compensation in PA?
In Pennsylvania, the maximum amount of workers' compensation wage loss benefits you can receive is determined each year by the Pennsylvania Department of Labor & Industry. It is based on the Statewide Average Weekly Wage (SAWW). For 2023, the maximum compensation rate was set at 66 2/3% of the SAWW, capped at $1,273 per week. This rate was applicable to employees whose wages at the time of injury were equal to or greater than $1,909.50 per week.
The specific amount you're eligible to receive will depend on your average weekly wage prior to the injury, but it cannot exceed the state-mandated maximum. This is to ensure that high earners do not receive disproportionate compensation compared to their actual earnings.
Adjustments & Cost of Living
It’s important to note that the maximum compensation rate is adjusted annually to reflect changes in the average wage. This adjustment ensures that workers’ comp benefits remain aligned with economic trends and inflation, providing fair compensation to injured workers each year.
What If I Need an Exception?
Our firm is used to handling complex cases that fall into specific legal categories. If you’re concerned that your insurer is going to take away your benefits or reduce them before you’re done recovering, then talk to our Pennsylvania workers’ comp attorneys. We’ve handled countless workers’ comp claims in Pennsylvania, and we’ll be more than happy to answer your questions and assert your rights under the law. Regardless of what you went through, you deserve every benefit promised to you under the Workers’ Compensation Act.
Speak with us in a free consultation: call (888) 498-3023 or contact us online today.