How to File a Workers' Compensation Claim in Pennsylvania

Learn when and how to file your Pennsylvania workers' comp claim.

Pennsylvania workers’ compensation pays benefits to employees who are injured on the job. Workers may receive medical treatment, compensation for wage loss, and other financial assistance. To collect benefits, you must meet certain requirements—including reporting your injury to your employer within a certain time frame.

How Does the Pennsylvania Workers’ Compensation System Work?

In Pennsylvania, most employers must have workers’ compensation coverage—either by purchasing a workers’ comp policy from a private insurance company or by receiving certification from the state to self-insure. (In general, only large, financially stable employers will qualify to self-insure.) The  Pennsylvania Bureau of Workers’ Compensation  oversees all workers’ comp claims in the state.

Like all other states, Pennsylvania has a no-fault workers’ compensation system. You do not need to show that your employer acted carelessly in order to receive benefits. As long as your injury happened on the job or was caused by your work activities, you will typically be eligible for benefits.

Eligible workers may receive a variety of benefits, including:

  • total and partial disability benefits
  • specific loss compensation (for amputations or loss of use of a body part)
  • reasonable and necessary medical care, and
  • vocational rehabilitation (training or education for a new line of work).
To learn more about these benefits, see  Types of Workers' Compensation Benefits.

How Do I Report an Injury?

Notifying your employer is the first step to starting a workers’ compensation claim. In Pennsylvania, you should notify your employer of a work-related injury within 21 days—either orally or in writing. If you fail to notify your employer of the injury within 120 days, you will lose your right to workers’ comp benefits.

Regardless, employees should provide notice and get medical treatment as quickly as possible. Employers and insurance companies are skeptical of delayed claims and tend to deny them. Giving notice and getting treatment early on will reduce the likelihood of a claim denial.

When you notify your employer, provide as much detail as possible, including:

  • when the accident happened
  • how you hurt yourself, and
  • what symptoms you are experiencing.

Your employer may also ask you to fill out a written accident report. When completing the report, be as accurate as possible. Accident reports are frequently used as evidence in disputed claims, and any inconsistencies may be used against you.

How Do I Get Medical Treatment?

If you need medical treatment, your employer should provide you with a panel of physicians to choose from. For the first 90 days of treatment, you typically must treat with a listed physician. After that, you can select your own treating doctor.

Accurate information helps your physician diagnose and properly treat your injuries, hopefully leading to a quicker recovery. Additionally, insurance companies rely heavily on medical records of initial treatment when they evaluate claims. Either downplaying or exaggerating your symptoms may result in a denial of benefits.

What Happens After I Report My Injury?

Once you report an injury, your employer must notify its insurance company of your claim. The insurance company will then investigate your claim and determine your eligibility for benefits. Its investigation may involve:

  • reviewing your medical records
  • analyzing your work experience, education, and wages
  • ordering a medical examination to assess your condition, and
  • sending you for a functional capacity evaluation (an assessment of your ability to perform work duties).

Under Pennsylvania law, the insurance company must either approve or deny your workers’ compensation benefits within 21 days of receiving your claim. (The insurance company can extend its investigation to 90 days if it pays your temporary disability benefits during that time.) If your claim is approved, you will start receiving disability payments and other benefits. Unfortunately, insurance companies deny many workers’ compensation claims. (For common grounds for a denial, see  Denied Workers' Compensation Claims.)

When Should I File a Workers’ Compensation Claim?

Workers do not need to file any paperwork with the Bureau unless the insurance company denies benefits. To appeal a denied claim, you typically must file a claim petition within three years of either your date of injury or your last benefit payment, whichever is later.

Unless your claim is very simple, you should consider hiring a workers’ compensation lawyer to handle your appeal. The insurance company will have a lawyer and you may be at a disadvantage if you proceed without an attorney. To learn more, see  Should I Hire a Workers' Comp Attorney or Can I Handle My Own Case?

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