Pennsylvania's workers' compensation law provides for employer-paid medical benefits and wage replacement income if an employee is injured or becomes ill in relation to the work environment. Receiving benefits does not depend on showing that the employer was negligent in any way. In exchange, employees are not able to sue their employers for such accidents.
Requirements for Insurance
Pennsylvania employers are required to maintain workers' compensation insurance even if they have only one employee. This requirement also applies to part-time workers and seasonal workers. Additionally, Pennsylvania requires employers to maintain workers' compensation insurance for employees who may be injured in another state but whose employment is principally located in Pennsylvania or who work under a contract made in Pennsylvania. Employers may purchase insurance through a private insurance company, through the state insurance fund or by self-insuring. Self-insured employers must set aside funds for this purpose and post security for future claims. Employers are responsible for this insurance and cannot pass the cost onto employees.
Pennsylvania workers' compensation laws pertain to most employees. Federal employees are covered under federal laws. Sole proprietors, business partners, executive officers, independent contractors who work out of their own home, domestic workers and licensed real estate brokers are exempt from coverage. Additionally, casual workers who do not perform work in the regular course of the employer's business, persons with exemptions due to their religious beliefs and agricultural workers who earn less than $1,200 in a calendar year are also exempted.
Workers' compensation does not cover injuries or deaths that are self-inflicted or caused by an employee's illegal act. This includes the illegal use of drugs. Injuries or deaths caused by intoxication may not be covered by workers' compensation.
Employees are considered to be totally disabled if they are not able to work and are considered at least 50 percent impaired, as determined by American Medical Association Standards. Employees who are considered to have a total disability receive a maximum of two-thirds of the statewide average weekly wage for the duration of their total disability. This may be until they die or until they are able to return to work and make the same amount of wages as the employee did before the injury or illness.
After 104 weeks of this status, an employer can request a medical examination to determine if the employee is still totally disabled.
Partial disability benefits are paid if the employee can or does return to work with restrictions in a lower paying job. These benefits are equal to two-thirds of the employee's average weekly earnings and can be paid up to 500 weeks.
Vacation pay is considered an earned benefit in Pennsylvania. As such, employees can choose to take vacation pay or not while their claim is pending. The employer cannot take credit for vacation pay. If the claim is later accepted, the employee will receive workers' compensation benefits for the time when he took vacation pay.
Filing a Claim
Employees must report the work-related accident or illness to their employer. The employer's insurance company has 21 days to deny or accept the claim. If this method does not provide satisfactory results to the employee, he may file a petition with the Office of Adjudication of Pennsylvania's Department of Labor and Industry.