An amputation is one of the worst work injuries you can face. Whether your injury involves a traumatic amputation during the accident itself or a surgical amputation is needed later, you can recover additional compensation for a lost limb.
Workers’ Comp typically pays for medical expenses, plus wage-loss benefits. This should include coverage for relevant prosthetics and rehabilitation. However, limb amputation is one of the injuries listed in the Workers’ Comp Act that pays additional “specific loss” benefits to injured workers.
For help with your injury case, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945.
What Medical Care Does Workers’ Comp Cover for Amputations?
When you receive medical care after a work-related accident, Workers’ Comp should pay for all of it. This should include, for example:
- Emergency room stays
- Surgical costs
- X-rays and MRIs
- Rehabilitation
- Physical therapy
- Occupational therapy.
Amputations usually require all of this care, and it can be quite expensive.
Choice of Doctor
It is also important to note that you may be limited to using certain doctors for the first 90 days. Employers create a list of at least six care providers, and you must use these listed providers, with some exceptions:
- You can choose another doctor if you need an unlisted specialist
- You can get a second opinion on surgery, but you still must use the approved surgeon if the surgery is in the first 90 days.
Coverage for Prosthetics
The cost of purchasing, being fitted for, and learning to use a prosthetic should all be covered. However, it should be covered at the reasonable cost of treatment, services, and medical devices.
This might mean that you could be covered for a basic prosthesis that can help you perform daily tasks or get back to work, but they might not be required to pay for more advanced prosthetic limbs that can bend realistically or that are rated for heavy physical use.
Specific Loss Benefits for Amputations
When you face certain permanent amputation, lost function, facial scarring, lost vision, or lost hearing, you can receive additional “specific loss benefits.” They are usually paid after your total disability period ends.
Rate
The Workers’ Comp Act sets the rate for these benefits at 2/3 of your Average Weekly Wage before the injury. They are capped at the maximum available benefit, which is the statewide average, set by law each year. They also have a floor at half that amount.
Duration
Each listed injury comes with a number of weeks the benefits are paid for:
- Hand – 335 weeks
- Forearm – 370 weeks
- Arm – 410 weeks
- Foot – 250 weeks
- Lower leg – 350 weeks
- Leg – 410 weeks
- Thumb – 100 weeks
- Index finger – 50 weeks
- Middle finger – 40 weeks
- Ring finger – 30 weeks
- Pinky – 28 weeks
- Big toe – 40 weeks
- Any other toe – 16 weeks.
Additional rules also apply:
- Permanent lost use counts the same as amputation.
- Amputation at or above a joint counts as total loss of everything below the next joint (e.g., amputation between the elbow and shoulder counts as the whole arm).
- For some amputations of half of a part, benefits are paid for half as long.
- Multiple finger/toe amputations typically get the benefits added together.
- Amputation of both hands, both feet, both arms, or both legs counts as total disability.
Healing Period
Amputations also have a “healing period,” which is the expected duration of your total disability period from that specific injury. For example, you are expected to be out of work for 20 weeks for loss of a hand.
During that time, you can receive lost-wage benefits. If you end up needing additional amputations, you can get additional healing periods, too.
Your specific loss benefits are then paid after those total disability benefits, even if you get back to work.
Wage-Loss Benefits for Amputation Victims
If you cannot work because of a work-related injury, then you can get wage-loss benefits, but there are special rules for amputations:
Rate
As long as you are not working at all, the pay rate is 2/3 of your average weekly wage from before the accident. This is capped at the statewide average weekly wage and has a floor of 1/2 that value or 90% of your pre-injury average wage, whichever is lower.
If you are working while receiving compensation, the rate is 2/3 of the difference in pre- and post-injury average weekly wages.
Special Rules for Amputation
Amputations are not always totally disabling, and people can get back to work in their same job or adapted jobs, potentially without facing much or any loss in earning power. However, it will take time to get back to work.
This does not apply if you lost both hands, both arms, both legs, or both feet; you are seen as totally disabled going forward.
This is where the healing period comes in. You can typically only receive total disability benefits during that healing period, then you are changed to partial disability benefits if you still have lost wages. These benefits can only last for 500 more weeks.
If you return to actual work, your rate changes based on the rules above for benefits while working. If you face no lost earnings, you get no wage-loss benefits.
FAQs for Workers’ Comp Amputation Cases in Pennsylvania
Can You Sue for an Amputation Injury at Work?
You cannot typically sue an employer for a work-related injury or amputation, but you can sue other at-fault parties. You cannot get compensated twice, so you might have to pay back the Workers’ Comp insurance company after you recover in your lawsuit.
Does it Make a Difference if it’s a Surgical or Traumatic Amputation?
As long as the amputation results from the work injury, whether the amputation happened in the accident or a surgical amputation was needed later shouldn’t affect eligibility for benefits. However, this might change when the amputation takes place along your journey for benefits.
Does the Affected Limb Change Your Benefits?
Each amputated limb has a different listing for how many weeks you get specific loss benefits.
What is a “Healing Period”?
Specific loss benefits are paid for a certain number of weeks just because you got injured, but wage-loss benefits may be limited to a shorter period. Each amputation injury has an expected healing period during which you can receive total disability benefits.
If you still have lost earning power after that, it may be for partial disability benefits only. This uses the same rules for pay rate but limits you to 500 weeks of wage-loss benefits.
Call Our Workers’ Comp Lawyers for Limb Amputations in Pennsylvania
If you lost a limb at work, call Cardamone Law at (267) 651-7945 for a free case evaluation with our Philadelphia Workers’ Comp lawyers today.
