Posted December 6th, 2018 by Jason Metz
Pennsylvania requires all businesses to have workers comp for employees, with only a few exceptions.
Workers compensation insurance generally pays medical bills and some lost income for an employee who's hurt while performing a job-related task. The types of injuries that can be covered by workers comp typically includes foot joint pain, breathing problems and broken bones.
Pennsylvania workers compensation law stipulates many details of who can be exempt from coverage, who must be covered and certain limits of workers comp payments. Below are many of the specifics contained in the workers comp law in Pennsylvania. The Pennsylvania Department of Labor & Industry also has a page with helpful information for employers.
Who must be covered by Pennsylvania workers comp insurance
Can any employees opt out of Pennsylvania workers compensation with a waiver?
Yes - corporate officers can opt out.
Is self-insurance for workers comp allowed in Pennsylvania?
Yes, for individual employers, groups of employers and political subdivisions. Political subdivisions in Pennsylvania are typically the state or a city, county, special district, school district or public agency.
By self-insuring, a business assumes responsibility for paying their own workers comp claims. A self-insured company typically hires a claims service company to handle claims administration and other services.
Are there exclusions for:
Small employers? No.
Agricultural employers? Yes, not covered unless the employee works more than a certain time period; when an employer pays more than a certain amount in wages.
Domestic employers? Yes, persons engaged in domestic service at the time of injury are excluded from coverage.
Independent contractors? Yes.
Casual employees? Yes.
Professional athletes? No.
Pennsylvania workers comp medical benefits
Is there a Pennsylvania workers comp fee schedule?
Fee schedules define payments for surgery, radiology, hospital services, chiropractic care, ambulance service, prescription drugs and other medical services for an injured worker.
Are there limits on medical treatment?
Who makes the initial choice of treating physician?
The employee, from a list provided by the employer; if no list, employee can treat with physician of their choice.
Disability payments for workers in Pennsylvania
Workers compensation generally helps replace some lost income when an employee can't work because of a job-related injury. State laws define some limits on the disability payment amounts and lengths, based on both temporary and permanent disability.
How are temporary total disability (TTD) payments calculated?
66 2/3% of the employee's pre-injury weekly wage, subject to a minimum and maximum.
Weekly minimum: 50% of statewide average weekly wage (SAWW) or 90% of the employee's average weekly wage (AWW), whichever is lower.
Weekly maximum: $978
Maximum length of TDD benefits: For the duration of the disability, subject to conversion to partial benefits at 104 weeks.
How are permanent total disability (PTD) payments calculated?
Pennsylvania law doesn't define PDD benefits.
How are permanent partial disability (PPD) payments calculated?
66 ⅔% of the difference between the employee's pre-injury average weekly wage (AWW) and their post-injury AWW or earning power.
Weekly minimum: N/A
Weekly maximum: $978
Fatality benefits under Pennsylvania workers compensation law
Maximum burial benefit: $3,000
Dependency benefits, weekly minimum : No less than 50% of the statewide average weekly wage (SAWW).
Dependency benefits, weekly maximum: $978
When do children's dependency benefits end? At age 18; age 23 if the child is a student; if child is disabled, benefits can continue for the duration of the disabilty.
Other injuries covered by Pennsylvania workers compensation
Mental stress with no physical injury? Yes.
Cumulative trauma (such as injuries caused by repeated exposure or repetitive motion)? Yes.
Occupational hearing loss? Yes.
Source: Workers Compensation Research Institute, May 2016 report
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