What Does Pennsylvania Workers’ Compensation Insurance Cover?

Over 2.5 million work-related injuries are reported each year in the United States. Injuries at work are costly for employers and employees. Workers’ compensation laws protect employees and employers. If you’ve been injured at work in Philadelphia, find out more by reading below.

What is Workers’ Compensation?

Being injured at work is frustrating, stressful, and frightening. You need to work and you want to work, but your job is the reason why you are injured or sick. You need medical care and you need to earn money to support your family.

Thankfully, the government has built in a safety net to (ideally) provide both.

Most employers in Pennsylvania must have workers’ compensation coverage for their employees. An employer that is required to carry workers’ compensation coverage faces civil and criminal penalties for breaking the law.

The workers’ compensation system is a no-fault process. It ensures that injured employees receive the medical treatment they need to recover from injuries.

A worker does not need to prove that the employer was negligent or at fault to receive benefits. Additionally, an employee receives benefits even if he or she was responsible for causing the injury.

There is a trade-off for receiving benefits under a no-fault system.

The system protects employers from being sued by employees for injuries occurring on the job. There may be a few exceptions for gross negligence or intentional injuries. For the most part, employees are limited to the benefits provided under the workers’ compensation system if they are hurt at work.

What Types of Compensation are Available for a Workplace Injury?

Workers’ compensation coverage is a type of insurance coverage. Many of the benefits a worker receives after a work injury are like the compensation a person receives for a car accident claim. There are some significant differences, though.

Workers’ compensation does not compensate an employee for pain and suffering damages. In a personal injury case, you could receive compensation for your pain and suffering. An employee injured on the job is not entitled to pain and suffering compensation.

Also, workers’ comp does not reimburse an employee for all loss of income related to the injury or illness. In a personal injury case, the accident victim could receive compensation for all loss of income related to the accident or injury.

These differences are trade-offs to balance the needs of injured employees with the requirement for employers to carry workers’ compensation coverage.

Types of Workers’ Compensation Benefits Available in Pennsylvania

There are several different types of workers’ compensation benefits an employee might receive after being injured at work.

Medical Treatment

Workers’ compensation should cover all costs for the necessary and reasonable treatment of work-related injuries and illness. The benefits include emergency room visits, doctor’s visits, hospitalizations, surgeries, medications, physical therapy, and medical devices.

Income Replacement Benefits

If an employee is unable to work because of an injury or illness, the system pays the worker for part of his lost income. A worker may receive benefits for total or partial disability. The amount of the benefit is equal to approximately two-thirds of the employee’s average weekly wages.

Specific Loss Benefits

Specific benefits are available for workers who lose a limb because of a work-related accident. There are also benefits available if a worker loses permanent use of a specific part of the body or sustains serious and permanent disfigurement of his face, head, or neck.

Death Benefits

The workers’ compensation system also provides benefits for surviving dependents when a work-related injury or illness results in the death of an employee. The benefits compensate dependents for financial losses and funeral expenses.

Exceptions to Receiving Workers’ Compensation Benefits

There are cases in which an employee may not be entitled to receive workers’ compensation benefits. Some examples of cases in which worker’s comp benefits would not be payable include:

  • Cases involving intentional self-inflicted injuries;
  • The injuries were caused because the worker was intoxicated or using illegal drugs;
  • The injury was intentionally inflicted to obtain workers’ compensation benefits fraudulently; and,
  • The injury did not occur within the normal scope of the person’s employment.

What Should I do if My Workers’ Compensation Claim is Denied?

The workers’ compensation system should be a straightforward process that provides benefits for employees hurt at work. That is not always the case. Injured workers are denied the benefits they deserve.

Often, insurance providers undervalue cases involving permanent disabilities and impairments or long-term workers’ compensation benefits.

There is a process for appealing workers’ compensation denials. Appealing a workers’ compensation claim can be a complicated process. If you have questions, it is best to contact a workers’ compensation lawyer to discuss your rights and options.


Zavodnick, Zavodnick & Lasky, LLC
123 S Broad St #1220
Philadelphia, PA 19109
(215) 875-7030