How Long Can I Stay On Workers’ Compensation In Pennsylvania?
- Dave Brown, Esquire
- 08/27/2024
You have been unlucky enough to get injured at work. Fortunately, the workers’ compensation insurance company for your employer has accepted your claim and started to pay you weekly workers’ comp. benefits. You may wonder to yourself – how long am I allowed to stay on PA workers’ comp.? Six months? A year? Five years? Ten years? We’re here to tell you.
In Pennsylvania, if you are hurt on the job and unable to work, you will receive what are called “total disability benefits.” Under the Pennsylvania Workers’ Compensation Act, theoretically you could receive these benefits indefinitely, for the rest of your life, although that happens very rarely.
The insurance company can stop paying you total disability benefits only if one of the following events occurs:
- You return to work for either your time-of-injury employer or another employer and start to earn wages. If you go back and earn as much money as you were making at the time of your injury, your workers’ comp. benefits will be suspended. If you return to work and earn less than what you were making when you were injured, you will still be entitled to benefits, “partial disability benefits” (more about them later), compensating you for your lost wages. Either way, your entitlement to total disability benefits will stop.
- A Workers’ Compensation Judge finds that you have fully recovered from your work injuries. Eventually the insurance company will send you for an “independent medical examination” with a doctor of its choice. If that doctor concludes that you have fully recovered from your injuries, the insurance company’s lawyer will file a Termination Petition, which will be decided by a Judge. Your lawyer will be able to fight this petition by presenting evidence – your testimony and the testimony of one of your treating doctors – that you have not recovered. After the Judge holds hearings, and depositions take place, the Judge will render a decision in your case. If the Judge finds that you have fully recovered, you will no longer be entitled to total disability benefits – or any type of benefits – in connection with your workers’ comp. claim.
- A Workers’ Compensation Judge finds that you are capable of working, even if you have not actually gone back to work. Your employer could offer you a job that is within the independent medical examination doctor’s restrictions – for example, medium-duty work – but you don’t go back because you don’t think you’re able to perform that level of work, and your doctor hasn’t released you. But if the Judge thinks you can do that level of work, your benefits will be suspended or modified. The Judge could also modify your benefits based on a “labor market survey” in which a vocational consultant, a person with expertise on the job market, determines your weekly earning power based on the wages of a number of jobs that the insurance company’s doctor has released you to perform. For example, suppose you were earning $800 per week in your job at the time you were injured. If a Judge finds that you have the capability to work and earn $500 per week, your total disability benefits will stop, and you will receive partial disability benefits at a lower rate.
- You reach a settlement in your case with the insurance company. If that happens, you will likely receive a lump sum of money, and your medical bills will be paid up until the time the Judge approves the settlement. Under most circumstances, if you were receiving total disability benefits and your case settles, those benefits will cease.
- If you have been receiving total disability benefits for at least 104 weeks (two years), the insurance company can require you to undergo an “impairment rating evaluation” with a doctor of its choice. This is similar to an independent medical examination in that a doctor will evaluate you and render opinions about your condition. With an impairment rating evaluation, though, the doctor will make a determination as to whether your “impairment rating,” which is based on a complicated formula, is 35% or higher. If the rating is lower than 35%, which it usually is, the insurance company will probably be able to change your benefits from total disability to partial disability. Your weekly rate won’t change but the length of time that you are entitled to receive benefits will.
This leads to the question of how long you can collect partial disability benefits. Some of the scenarios we have discussed involve you receiving partial disability benefits – going back to work making less money than you were making, a Judge finds that you are capable of working with a wage loss, or an impairment rating doctor determines you have an impairment rating of less than 35%. In these situations, your benefits will transition from total disability to partial disability and there will be a cap of 500 weeks (about nine and a half years) on your entitlement to receive these benefits. During this 500-week period, the insurance company may petition to terminate your benefits or enter into a settlement with you to resolve your claim.
So there you have it – a snapshot of how long you can receive total disability and partial disability benefits, and the circumstances which will cause these benefits to stop.
One other important piece of information we want to pass on to you: if you get injured at work, whether your claim has been denied, you’re receiving total disability benefits, or you’re receiving partial disability benefits, you should contact Pearson Koutcher Law to represent you in your claim. At Pearson Koutcher Law, workers’ comp. is all we do, 100% of the time. Our firm is comprised exclusively of lawyers who have been representing injured workers for at least 25 years. Please contact us for a free comprehensive consultation and let our experience and knowledge help you obtain the best possible result in your case.
