How Are Workers’ Comp Settlements Calculated in Pennsylvania?

If you get hurt at work and you are considering a Workers’ Compensation claim, it is important to know how settlements work, what they cover, and how your benefits are calculated.  Many workers just want to know what they are entitled to and whether settlements are fair.  While we obviously recommend you work with a lawyer to know for sure on your case, the following information can help you begin to understand what goes into a settlement and how it is calculated.

Workers’ Comp settlements should cover everything that your case would have paid if you instead got ongoing benefits.  Total benefits in a Workers’ Comp claim usually include the total cost of medical expenses – both now and into the future – as well as lost earnings.  There are particular formulas for calculating lost earnings, making this somewhat of a simple calculation, but we have to know how much time you will miss at work to be able to calculate these costs.  Additionally, if you suffered permanent losses or other harms qualifying for “specific loss” benefits, the money paid for these will be listed by statute.

For help with your specific case, call Cardamone Law at (267) 651-7945 to speak with our Certified Pennsylvania Workers’ Compensation Lawyers today.

Settling a Workers’ Comp Claim in Pennsylvania

If you qualify for Workers’ Comp benefits, then your benefits would typically be paid as you go.  This means getting coverage for any medical bills, billed directly to your employer’s Workers’ Comp carrier (though some expenses are instead paid out of pocket and reimbursed later).  It would also mean receiving wage-loss benefits as you go, with weekly or bi-weekly checks issued to match your pay schedule before the injury.  You may get these benefits whether you are totally or partially disabled, with total disability checks potentially coming for the rest of your life.  You can also get periodic checks for “specific loss,” discussed in further detail below.

If you instead settle your case, you are given a “lump sum” payment that covers all of these expenses.  This settlement must be enough to cover all of these payments, except it is paid all at once (though annuities are sometimes available).  This means converting the value to “present value” with some specific calculations.

Settlements are often paid because, first, injured workers often want their money now, not in weekly payments for years to come.  Second, insurance carriers do not want to keep cases active and open forever; they want to pay damages and close cases so they can move on to administering and settling other cases.  Ultimately, settlements are often good for everyone, but only when damages can be reasonably ascertained.

In some cases, your state of disability might fluctuate between partial and total or future medical care costs might be so unknown that settling might not be fair.  In any case, our Philadelphia Workers’ Comp lawyers can help you understand whether a settlement is good in your case and advise you on what to do.

Calculating Medical Expenses for Workers’ Comp Settlements in Pennsylvania

Medical care costs can be difficult to calculate in some cases, but in others, they are quite simple.  It all depends on what care you already received, what care is to be expected, and how certain you can be of these future costs.

Calculating Past Expenses

If you already got some medical care for your injury that you had to pay for out of pocket because Workers’ Comp refused to cover it, then you know what your past medical expenses cost.  We can total up all these costs from bills and financial records and demand them in your case.

Future Medical Expenses

Future care costs are harder to ascertain.  In many cases, we need to hire financial experts and medical experts to testify about your condition and what ongoing/future care you will need.  In doing so, we need to take into account potential trends in healthcare costs, how your condition usually changes or develops, and what the care will cost in present value.

In many cases with future medical expenses, we need to use a Medicare Set Aside to prove to Medicare that the insurance carrier covered your future care costs for this injury and that you will not be billing them for the care.

Certainty

Some medical conditions and injuries have a set track and are unlikely to get worse, making costs more predictable.  If your condition will fluctuate and change, a settlement might be inappropriate or hard to calculate.  In any case, our lawyers and the experts we use can help determine costs and whether future care costs are predictable or not.

Wage-Loss Benefits for Workers’ Comp Settlements in Pennsylvania

Wage-loss benefits are somewhat easier to calculate, given that there are set numbers to work with.  However, there are considerations based on whether your benefits are for total disability or partial disability, whether your condition will fluctuate back and forth between the two, and how your future health and ability to work will be affected.

Total Disability

Total disability benefits equal 2/3 of your average weekly wage (AWW) from before the injury.  Pennsylvania also sets a statewide AWW that acts as a cap, so you cannot get more than that amount per week.  You also cannot get less than 1/2 that statewide AWW or 90% of your AWW, whichever is lower.

For 2025, the AWW is $1,347.  You simply calculate total disability by multiplying 2/3 of your AWW (up to that cap) by the number of weeks you will be totally disabled.

Partial Disability

Partial disability pays 2/3 of the difference between your pre-injury and post-injury AWW, which might change over time depending on how your condition changes.  You cannot get more than 500 weeks of partial disability, so this also has a cap.

To calculate, you multiply the 2/3 value by the number of weeks you will be partially disabled, up to 500.

Future Health and Ability

To calculate these values, we need to know how many weeks you will be totally disabled for and how many weeks you will be partially disabled for, though they don’t need to be consecutive.  This means taking into account how you will heal, when you will be able to return to work, and – if you cannot return to work – how much longer you will work for before retirement.  Experts can help us make these calculations, along with estimating future earnings if you work with partial disabilities.

Specific Loss Benefits for Workers’ Comp Settlements in Pennsylvania

Specific loss benefits are specifically listed in the statute, with various numbers of weeks of AWW payments assigned to each injury.  From permanent loss/amputation to facial scarring to lost sight or hearing, each injury can be found there, making calculations for specific loss payments quite simple.

Call Our Certified Pennsylvania Workers’ Comp Specialists Today

Call (267) 651-7945 for a free case evaluation with Cardamone Law’s Bucks County Workers’ Compensation lawyers.