Who Qualifies for Workers’ Comp Benefits in Pennsylvania?

In PA, the Department of Labor and Industry oversees workers’ compensation. Workers’ comp is a form of disability benefits established to help injured workers. The law requires employers to carry workers’ compensation insurance for all employees.

Workers who have suffered an injury, illness, or occupational disease as a result of their job may qualify. Covered by workers’ comp, full time, part time, and seasonal employees may meet the criteria. Workers’ compensation coverage includes lost wages and medical expenses. Also, if an employee dies as a result of their job, workers’ comp may provide a death benefit for the family. 

This guide hope to explain PA workers’ comp laws, including rights, jurisdiction, notice rules, and time limits for filing claims. Employees need to know the rules if they suffer an injury to protect their rights and get the benefits they deserve. 

Who Is Eligible For Workers’ Compensation?

To qualify for workers’ compensation benefits, the injury must relate to and arise from the employment. This includes both physical injuries sustained at the workplace and illnesses directly resulting from job-related activities.

More specifically, a clear connection between the job and the employee has to exist. The injury must take place while doing work-related tasks or relate to the job in some way.

Employment Relationship

The claim hinges on a valid employment relationship. The law requires that the injured party must have an employer-employee relationship.  An Independent contractor does not typically qualify for workers comp benefits.

Nature of Injury and Work Relation

For an injury to qualify for workers’ comp, it must occur within the scope of the employment. This means that the injury should relate to the tasks or duties assigned as part of the job or occur on-site. For example, if a worker suffers an injury from a slip and fall while walking to their desk at work, they may receive benefits.

If I Get Hurt at Work In PA, Do I Get Workers’ Comp?

As long as you qualify as an employee and the injury falls within the course and scope of your employment, likely, yes. Workers’ comp covers most workplace injuries that occur within Pennsylvania. Always talk to a lawyer regarding the particulars of your case.

General Rule in Pennsylvania

The Act applies to all work injuries within Pennsylvania. The act also covers injuries outside Pennsylvania under specific conditions. For more information, see the McIlvaine Trucking Inc. v. WCAB (States) case.

Jurisdiction Outside Pennsylvania

Under certain conditions, the law covers injuries that happen outside PA. These conditions apply when a job mainly happens in PA or when signing the hiring contract occurs in PA. This provision ensures that employees who travel out of state for work-related purposes remain covered under the Act.

Disputes in Multi-State Employment

For employees working across state lines, disputes often arise over which state’s law applies. The law deals with this by looking at where the employee works and where they signed the employment contract. This approach provides clarity and fairness in determining jurisdiction, especially in cases of mobile or multi-state workers. A lawyer can help you to determine the best place to file a claim.

What Time Limits Apply to Workers’ Compensation Claims?

You must give notice of your injury within 120 days of the injury. The law requires employer notification of an injury within 120 days from the injury date. This rule mandates prompt reporting of injuries to ensure timely processing of the claims. It can also help with early injury treatment, which could result in faster recovery and return to work.

To receive retroactive benefits back to the date of injury, employees must report their injury within 21 days. After those 21 days, the benefits will begin from the date of notice. If the employee fails to report their injury after 120 days, the employee may lose all rights to their benefits. 

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The Discovery Rule

The discovery rule extends the time for notifying the employer about an injury and its connection to work. This extension lasts until the employee becomes aware or should reasonably become aware of it. This rule applies when injuries or illnesses that develop slowly. For example, repetitive stress injuries or occupational diseases/illnesses that arise from the employment.

Legal Notice Depends on the Totality of Circumstances

You need to provide a clear description of the injury and follow the rules for notification. See Sections 312 and 313 of the Act (77 P.S. §§ 632 and 633) for the complete requirements. Keep in mind, late notice can affect an employee’s eligibility to receive workers’ comp benefits.

The injured worker must tell their employer or representative about their injury. The employee should tell their employer how the injury happened and how it relates to the job. The worker should always put this in writing, when possible, to have a record of this notice. This will help if and when a dispute arises.

Is There a Time Limit to File A Workers’ Comp Claim?

Yes. A 3 year time limit applies for filing a claim petition, counting from the date of injury.

General Time Limits

Section 315 of the Act requires an injured worker to file a claim petition within 3 years of the date of injury. This limitation underscores the importance of timely action in pursuing a workers’ comp claim.

Statute of Limitations-Exceptions

Scenarios such as commutation of partial disability, or the payment of specific loss benefits, can influence the time limit. These situations reflect the Act’s flexibility in handling different types of injuries and the issues surrounding them.

Other situations may extend the timeline as well. For instance: employers lying, withholding medical records, or paying for injuries in other states.

This rule prevents workers from unfair punishment for issues beyond their control. These situations might include employer fault or not receiving important information in a timely fashion. Always talk to a lawyer to see how this would apply in your particular case.

Impact of Late Discovery

If injuries appear later, like from long-term exposure, the time limit to report them may extend. This extension helps employees file claims for work-related injuries by addressing the challenges in identifying their cause. Always talk to a lawyer to see how this would apply in your particular case.

Conclusion

The workers’ comp system in PA can seem overwhelming, especially while going through a work injury. It has so many rules, so many deadlines, and a bunch of exceptions. Getting through the process requires a deep understanding of each of these rules, deadlines, and exceptions.

For injured workers, navigating this process can add stress to their already stressful situations. Don’t go through this alone, let us handle it. The insurance company has a lawyer on their side, so why don’t you?

If you need help with your claim or have any questions, give us a call. Reach out to our offices 24/7 for a free and confidential case evaluation (215) 609-4183.