Injured workers ask us the same questions in roughly the same order. These are the answers, written to be read quickly.
Anything here that applies to your situation is worth a longer conversation. You can reach Zavodnick & Lasky Personal Injury Lawyers at +1 (215) 875-7030.
Starting a Claim
What is workers’ compensation in Pennsylvania?
Workers’ compensation is insurance that most Pennsylvania employers must carry. It pays medical treatment and partial wage replacement to employees injured on the job, regardless of who caused the accident. In exchange, employees generally cannot sue their own employer for the injury.
The tradeoff cuts both ways. You give up the right to sue your employer, and you gain a system that pays without any argument about fault. The state publishes its own plain-language overview, Workers’ Compensation and the Injured Worker, which is worth reading alongside this page.
Do I have to prove my employer did something wrong?
No. Pennsylvania workers’ compensation is a no-fault system, so you do not have to show negligence, an unsafe condition or a rule violation. You only have to show that you were injured in the course of your employment and that the injury caused your disability or need for treatment.
How soon do I have to report a work injury in Pennsylvania?
Report it within 21 days and your benefits run from the date of the injury. Report it between 21 and 120 days and benefits run only from the date you gave notice. Report it after 120 days and the claim is barred completely.
What is a Notice of Compensation Payable?
A Notice of Compensation Payable, or NCP, is the document an insurer issues when it accepts your claim. It names the accepted body parts and the wage rate your checks are based on. Both are worth reading closely, because anything left off the NCP is effectively not part of your claim.
I was hurt at work today. What should I actually do first?
Tell a supervisor before you leave, get medical care the same day, and make sure the medical record says the injury happened at work. Those three steps close off the arguments insurers use most often. Our guide to the first 72 hours after a work injury walks through the sequence.
Medical Treatment
Which medical expenses does Pennsylvania workers’ comp pay for?
Comp pays reasonable and necessary treatment for the accepted work injury with no deductible and no copay. That includes emergency care, surgery, hospital stays, prescriptions, physical therapy, diagnostic imaging, medical equipment and mileage to appointments in some cases.
Bills tied to body parts the insurer never accepted are a frequent source of dispute, which is why the accepted-injury description on your paperwork matters.
Can I get a second opinion if my employer’s doctor recommends surgery?
Yes. Pennsylvania law allows a second opinion from a provider of your choosing at the insurer’s expense when surgery is invasive, and you are not required to follow the first recommendation. If the two doctors disagree, you may choose the course of treatment you prefer.
What is utilization review and why did my treatment stop?
Utilization review is the process an insurer uses to challenge whether treatment is reasonable and necessary. Once a request is filed, the insurer can stop paying for that treatment while a neutral reviewer evaluates it. A finding in your favor restores payment, including for the disputed period.
Utilization review is not a decision that your injury is fake. It is a decision about one course of treatment, and it is appealable to a workers’ compensation judge.
Do I have to attend an examination scheduled by the insurance company?
Yes, within limits. Pennsylvania allows the insurer to schedule a reasonable examination, generally no more than twice in a twelve-month period, and refusing without good cause can suspend your benefits. The examining physician is selected and paid by the insurer, so the report is not neutral.
Money and Benefits
Why is my workers’ comp check smaller than my paycheck?
Wage loss benefits replace roughly two-thirds of your average weekly wage, not all of it, and they are capped. For injuries on or after January 1, 2026, the maximum is $1,394.00 per week, matching the statewide average weekly wage published by the Pennsylvania Department of Labor & Industry.
Lower earners are paid on different formulas that can work out to more than two-thirds. If your check looks wrong, the wage calculation is the first place to look, because overtime, tips, bonuses and concurrent employment all belong in it.
Are workers’ compensation benefits taxable?
No. Workers’ compensation wage loss benefits are not subject to federal or Pennsylvania income tax, and they are not reported as wages. That is part of why the two-thirds figure lands closer to your take-home pay than it first appears.
What am I entitled to if my injury is permanent?
If you cannot return to any work, total disability benefits continue with no fixed week limit while that status holds. If you can work in some capacity, or your status is converted after an impairment rating, partial disability benefits are capped at 500 weeks.
What is a specific loss award?
A specific loss award is a set number of weeks of benefits for the permanent loss of use of a body part, loss of hearing, or serious and permanent disfigurement of the head, face or neck. The number of weeks is written into the statute for each body part, and the award is paid whether or not you have returned to work.
Can I collect Social Security Disability and workers’ comp at the same time?
Yes, though the combined amount is usually capped at 80% of your prior average current earnings, and Social Security reduces its payment to stay under that ceiling. How a comp settlement is worded can change the size of that offset considerably.
When the Claim Gets Contested
My workers’ comp claim was denied. What do I do now?
File a Claim Petition with the Bureau of Workers’ Compensation and the case goes to a workers’ compensation judge who hears it without deference to the adjuster’s decision. You have three years from the date of injury to file, and the petition forms are published by the Pennsylvania Department of Labor & Industry. Our page on denied workers’ comp claims covers the common denial reasons and the appeal path.
How long do I have to appeal a workers’ compensation judge’s decision?
Twenty days from the date the decision is circulated, filed with the Workers’ Compensation Appeal Board. A further appeal to Commonwealth Court runs 30 days from the Board’s order. These are calendar days and they are not extended while you look for a lawyer.
What is an IRE and why did my benefits change to partial disability?
An Impairment Rating Evaluation, or IRE, can be requested by the insurer after you have received 104 weeks of total disability. A physician designated through the Department of Labor & Industry assigns a whole-body impairment percentage. Under Act 111 of 2018, a rating below 35% converts your status from total to partial and starts the 500-week cap.
Your medical condition does not have to change for this to happen. The conversion is challengeable, and the timing of it is worth attention.
Can the insurance company have me followed?
Yes. Surveillance is legal in public and is common in longer claims, particularly before hearings and independent medical examinations. Social media is reviewed as a matter of routine. Nothing about this requires you to change how you live, but it is a reason to be accurate about your restrictions rather than optimistic.
Can I be fired while I am on workers’ comp?
Pennsylvania is an at-will state, so an employer may terminate for reasons unrelated to the claim, and accepted wage loss benefits generally continue afterward. Firing someone in retaliation for filing a claim is unlawful. Our page on workers’ comp benefits after termination separates the two situations.
Ending the Claim
What is a compromise and release settlement?
A compromise and release is a lump sum that closes your claim, usually permanently, and it has to be approved by a workers’ compensation judge at a hearing. It can resolve wage loss alone or wage loss and future medical treatment together. Once approved, it generally cannot be reopened if your condition worsens.
Do I have to accept a light-duty job my employer offers?
Usually yes, if the job is within your documented medical restrictions and was properly offered. Refusing suitable work can suspend or reduce your benefits. If the offered job exceeds your restrictions, or the restrictions came from an examination you disagree with, that is a dispute a judge can resolve.
What happens to my claim if I move out of Pennsylvania?
Your claim stays in Pennsylvania and continues to be governed by Pennsylvania law. You can treat with providers where you live, and hearings and depositions are frequently handled remotely. Insurers sometimes treat a move as an opening to challenge ongoing benefits, so keep the medical documentation current.
Coverage and Eligibility
My employer says I am an independent contractor. Am I out of luck?
Not necessarily. What controls is how the work was actually directed and controlled, not the label on your paperwork or the fact that you received a 1099. Misclassification is common in construction, delivery and staffing arrangements. See workers’ comp exemptions in Pennsylvania for how these are analyzed.
Does comp cover an illness that developed over years on the job?
Yes, occupational diseases are covered, including conditions from repeated exposure to chemicals, dust, noise and biological hazards. The clock generally runs from when you knew, or reasonably should have known, that the condition was work-related, which is different from the rule for a single accident.
Someone other than my employer caused my injury. Can I do anything about that?
Yes. A claim against a third party, such as a contractor, a driver, a property owner or an equipment manufacturer, can run alongside your comp claim and reaches damages comp does not pay, including pain and suffering. Our workplace accident page covers those claims.
Still Not Sure Where Your Claim Stands?
Most of these answers come with a version that only applies to your specific paperwork. Bring us what the insurer sent you and we will read it with you.
Zavodnick & Lasky Personal Injury Lawyers, +1 (215) 875-7030.
For the full picture on benefits, rates and deadlines, start at Philadelphia workers’ compensation.
Reviewed by the workers’ compensation team at Zavodnick & Lasky Personal Injury Lawyers, which represents injured workers before workers’ compensation judges in Philadelphia County and the surrounding counties. Answers here are general information about Pennsylvania law and not advice about a specific claim.
