When a workplace injury occurs, knowing how to navigate Pennsylvania’s workers’ compensation system can make all the difference. This guide breaks down everything you need to know about filing a claim, receiving benefits, handling denials, and hiring an attorney if needed.
What Is Workers’ Compensation?
Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries or illnesses. These benefits help cover medical expenses, lost wages, and other costs associated with a workplace injury.
In Pennsylvania, employers are legally required to carry workers' compensation insurance, ensuring that injured employees receive financial support without having to prove employer negligence.
Seek Medical Attention Immediately
If you get injured at work, your first priority should be seeking medical treatment. Even if your injury appears minor, you must visit a doctor to ensure your health is not at risk.
Key Steps to Follow:
- Inform the doctor that your injury is work-related.
- Check with your employer for a list of approved physicians (if applicable).
- Follow all medical advice and treatment plans to prevent disputes in your claim.
Note: If your employer has a list of approved physicians, you must see one of them for the first 90 days. After that, you may choose your own doctor.
Report the Injury to Your Employer
When to Report Your Injury
Pennsylvania law requires employees to notify their employer of a work-related injury within 21 days to receive full benefits. If you fail to report within 120 days, you may lose the right to claim compensation.
Information to Provide:
- Date and time of the injury
- Location where the accident occurred
- Details about how the injury happened
- Names of any witnesses
It is always best to report the injury in writing to create a documented record. If your employer does not file your claim, you may take further legal action.
Employer’s Workers’ Compensation Insurance Review
Once you report the injury, your employer must file a First Report of Injury (FROI) with the Pennsylvania Bureau of Workers’ Compensation. The employer’s workers’ compensation insurance company then has 21 days to accept or deny your claim.
Possible Outcomes of Your Claim:
- Notice of Compensation Payable (NCP): Your claim is approved, and benefits begin.
- Temporary Notice of Compensation Payable (TNCP): Your claim is approved temporarily but may be re-evaluated within 90 days.
- Notice of Compensation Denial (NCD): Your claim is denied.
If your claim is denied, you have the right to appeal (see Step 5 below).
Begin Receiving Benefits (If Approved)
If your claim is approved, you will start receiving workers' compensation benefits based on your injury and situation.
Types of Workers’ Compensation Benefits in Pennsylvania
| Benefit Type | What It Covers |
| Medical Benefits | Doctor visits, surgeries, physical therapy, prescriptions |
| Lost Wage Benefits | Partial income replacement if you cannot work |
| Specific Loss Benefits | Compensation for amputation or permanent injury |
| Death Benefits | Financial support for dependents of a deceased worker |
Lost wage benefits typically cover two-thirds of your average weekly wage, up to a state-mandated maximum.
Appealing a Denied Workers’ Compensation Claim
If your claim is denied, you have the right to appeal through Pennsylvania’s workers’ compensation system.
How to Appeal a Workers’ Compensation Denial
- File a Claim Petition with the Workers’ Compensation Office of Adjudication.
- A Workers' Compensation Judge will schedule a hearing to review evidence.
- Present medical records, witness testimony, and other proof to support your claim.
- If the judge denies your claim, appeal to the Workers’ Compensation Appeal Board.
- If necessary, escalate your case to the Commonwealth Court of Pennsylvania.
Hiring a Workers’ Compensation Attorney
If your claim is denied, delayed, or undervalued, hiring a workers' compensation attorney can significantly improve your chances of getting the benefits you deserve.
How an Attorney Can Help:
- File appeals and meet deadlines
- Gather strong medical and legal evidence
- Negotiate with insurance companies
- Represent you in hearings and court
Most workers' compensation attorneys work on a contingency basis, meaning they only get paid if you win your case.
Frequently Asked Questions
How long do I have to file a claim?
You must report your injury to your employer within 21 days to receive full benefits. If you fail to report within 120 days, you may lose your right to compensation.
What if my employer refuses to file my claim?
You can file a Claim Petition with the Pennsylvania Bureau of Workers' Compensation and seek legal representation if necessary.
Can I choose my own doctor?
You must visit an employer-approved doctor for the first 90 days if they provide a list. After that, you can select any doctor you prefer.
What happens if I return to work but still have medical issues?
You may still qualify for medical benefits and partial wage loss benefits depending on your condition and work capacity.
What if my injury was my fault?
Workers' compensation is no-fault insurance, meaning you can still receive benefits unless the injury was caused by drug/alcohol use or intentional misconduct.
Final Thoughts: Protect Your Rights
Filing a workers’ compensation claim in Pennsylvania can be a complex process, but knowing your rights and taking the proper steps can help ensure you receive the benefits you deserve.
If your claim is denied, delayed, or undervalued, do not hesitate to seek legal advice. A workers’ compensation lawyer can help you appeal and fight for the compensation you are entitled to.
Contact Fulginiti Law Today
If you're struggling with a workers' compensation claim or facing a denial, consult an experienced attorney to protect your rights. An attorney can guide you through the appeals process and help maximize your benefits.
Don’t wait—Contact Fulginiti Law to ensure you receive the compensation you deserve.
