Each state has its own individual process in place for handling workers’ compensation claims. If you develop an occupational illness or workplace injury in Pennsylvania, we’ve outlined the steps you’ll take for filing your claim below. We also have a handy chart showing the Pennsylvania workers’ compensation program statistics for the last five years, according to the Bureau of Labor Statistics.
Which Workers Are Exempt from Pennsylvania Workers’ Compensation Coverage?
Every employer with at least one part-time or full-time employee must carry Pennsylvania workers’ compensation insurance. However, certain employees are automatically exempt from this coverage under state law, including:
- Federal workers
- Railroad workers
- Agricultural laborers
- “Casual” employees (i.e., people employed temporarily in positions without regular hours)
- Domestic workers employed in the household
- Shipyard and harbor workers
If you work for a business as a seasonal, part-time or full-time employee, your coverage begins on day one at your job.
How to File Your Pennsylvania Workers’ Compensation Claim
According to the Pennsylvania Bureau of Workers’ Compensation (BWC), follow these steps to apply for benefits:
- Notify your supervisor as soon as possible (but within 21 days) about your incident. If you fail to report it within 120 days, state law disqualifies you from collecting any benefits.
- If you miss at least one work shift, then your employer must file a first report of injury form with the BWC.
- Your employer’s insurer must either approve or deny your claim within 21 days and notify you in writing. In some cases, the insurer can extend your claim’s initial review period by 90 days. Whenever this 90-day extension occurs, you’ll typically receive temporary disability benefits during that period.
- If approved, you should receive an Agreement for Compensation (LIBC-336) letter in the mail. Your employer may also require an examination with their preferred provider to confirm your diagnosis.
- You must miss at least seven calendar days of work before you’ll qualify for lost-wage benefits. Those can begin on your eighth missed workday after reporting your illness or injury. Your first seven days off are unpaid, unless you miss at least 14 days of work. Then, you’ll get lost-wage benefits for your first unpaid week off.
- If denied, you’ll receive a mailed Notice of Workers’ Compensation Denial (LIBC-496) letter.
- To appeal your claim’s denial, file a Claim Petition (LIBC-362) with the BWC to request a hearing. You must plead your case before a workers’ compensation judge within three years of your incident.
Since each Pennsylvania workers’ compensation claim is different, your own experience may vary. You may also wish to review this Pennsylvania workers’ compensation process flowchart from the BWC.
Pennsylvania Workers’ Compensation Statistics, 2015-2019
The annual workers’ compensation report from the Bureau of Labor Statistics (BLS) includes program statistics for most states. This yearly report shows total workers’ compensation claims, those who changed jobs or missed work, and claims by employment sector. See where Pennsylvania workers’ compensation claims fell from 2015 to 2019 in our interactive chart below:
During this time period, the biggest data point of note is that service-industry workers file nearly 7 in 10 claims per year (66%-70%). Total claims fell 13% from 2015-2017, while service-industry claims fell 7% during that same timeframe. In most years, just over half of all injured workers qualify for lost-wage benefits (50%-55%). If your injury’s not bad enough to need time off to recover, then workers’ comp only covers your medical bills.
You May Qualify for Legal Assistance
Still have questions about how the Pennsylvania workers’ compensation process works? Sign up for a free phone call with a workers’ comp attorney who can answer your questions privately. Whether you just want someone to review your paperwork or you need help filing your appeal, you’ll pay nothing for that initial consultation. Plus, all workers’ comp attorneys work on contingency. That means if you don’t win a cash settlement, then you pay $0 for legal assistance. But if you do win, then you’ll only pay a small, one-time fee.
Ready to see if you may qualify? Click the button below to start your free online benefits evaluation now!