How Long Can You Collect Workers’ Comp Benefits in Pennsylvania?

Workers’ Compensation is meant to cover you as long as you cannot work after an injury, and the benefits can theoretically last a lifetime, but there are often practical considerations that make your coverage shorter than you might hope.  Your employer or their insurance carrier will also work to cut off benefits in many cases, putting your benefits in jeopardy after some time.

Benefits can last indefinitely if your injury results in a permanent disability that renders you unable to earn money.  However, after 2 years of total disability benefits, you will likely undergo periodic impairment ratings to test whether you are still totally disabled.  If you are not, you could be reduced to partial disability benefits, which end after 500 weeks (~9.6 years).  Being reduced to a partial after an Impairment Rating doesn’t mean your check goes down, but gives the insurer that 500 week cap on wage loss benefits. If you return to work, or if a Workers’ Compensation Judge finds that you have an earning power, you also get bumped down to partial benefits with a 500-week limit.  Your benefits may be terminated if a Work Comp Judge finds that you are fully recovered.

For help with your work injury claim, call Cardamone Law’s Certified Philadelphia Workers’ Compensation Lawyers at (267) 651-7945 today.

When Do Workers’ Compensation Benefits Start in Pennsylvania?

To determine how long your benefits last, you need to look at the start date first.  Under the Pennsylvania Workers’ Compensation Act, specifically § 306(e), your benefits will not start until you have been out of work for 7 days.  At that point, you can start drawing wage-loss benefits.  Once you hit 14 days of being out of work, you can get the first 7 days paid back.  However, you also have to get your claim approved first before these benefits can start. Remember, you cannot get any wage loss benefits until you give notice of your injury to your employer.

From the date of your injury, you have a maximum of 120 days to give notice of the injury to your employer, or your claim is forever barred. The sooner you give notice, however, the better, since you cannot seek wage loss benefits until notice is given.  Once notice is given, the employer/insurer gets 21 days from your notice to respond to your claim.  If they grant you benefits or start you on benefits temporarily, the benefits can start then.  If the benefits are only granted temporarily, the acceptance can be revoked within a 90 day period. If they deny your claim or fail to respond, we have to go to court, and it will not be until the judge grants you benefits or you reach a settlement that the benefits actually start flowing. Assuming notice of the injury is given, you have a maximum of three years in Pennsylvania to file a Claim Petition for benefits, from the date of injury, or from the date you first believed that your injury may be work-related.

Medical benefits start immediately and cover any emergency care, too.

When Do Workers’ Comp Benefits End in Pennsylvania?

Our Allentown Workers’ Comp lawyers can help you fight to get and keep benefits for as long as you are unable to work or face a loss in earning power because of a work-related injury.  This technically means that benefits can last for the rest of your life, but this is unlikely to happen.

If you start with total disability benefits, they will end under three circumstances.  In many cases, this will convert your benefits to partial disability benefits, which will end after 500 weeks.

Impairment Rating Changes

Total disability benefits can go on for 104 weeks – i.e., 2 years – without interruption if you are deemed totally disabled and unable to work.  At that point, you can be ordered to undergo an impairment rating evaluation (IRE), where they will assign you an “impairment rating.”  If you are found to have 35% impairment or higher according to the American Medical Association’s published standards, you are still deemed totally disabled and can keep getting total disability benefits, which means no 500 week cap.

If your impairment rating is found to be under 35%, then your total disability benefits will stop and be converted to partial disability benefits, which last for 500 weeks max (~9.6 years).

However, it is important to consider that your employer/their insurance carrier can continue to request Independent Medical Exams every 6 months (i.e., no more than 2 per year).  These doctors often claim a full recovery- and if they are successful in showing this before a Workers’ Compensation Judge, then your benefits will end.

You Return to Work

If you return to work, then you can no longer claim you are “totally disabled.”  Instead, you would be converted to partial benefits covering 2/3 of the difference between your pre-injury average weekly wage before the injury and your current gross weekly wages.  This would be paid instead of the “total disability” benefit of 2/3 of your pre-injury wages.

You can continue receiving partial disability benefits like this for 500 weeks max.

You Get Better

If you “get better” within the first 90 days, it is likely you will be seeing a doctor that the insurance carrier picked.  They will be able to report your improvement to your insurance carrier, and they will be able to ask for your benefits to be terminated. Their lawyer will file a Petition to Terminate benefits, and you will need a Certified PA Work Comp Lawyer to assist.

Similarly, if your doctor, or an Independent Medical Examiner opines that you’re fully recovered from your work injury, they will file a Petition to Terminate benefits. Your benefits will not stop just because they filed this type of petition. But there will be a request for Supersedeas at the first hearing and if you don’t respond appropriately and win, the wage loss benefits can be shut down during the litigation. If you ultimately win the case on the merits, after about one year in court, then you can get back the wage loss benefits, plus interest.

Note that an improvement in your condition doesn’t mean you’re fully recovered. To be fully recovered means all disability relating to the accepted injuries has ceased.  You should be symptom-fee, and able to return to your pre-injury job with no restrictions, and have no need for future medical treatment.

How Long Do Benefits Last After a Settlement?

A settlement usually pays you all of the benefits you agree to all at once.  Because of this, the case is over and there are no more benefits to come in after the settlement is paid. There are some rare cases where the insurer will agree to keep medical benefits open for a period of time. But this doesn’t happen too often.

Call Our Workers’ Compensation Attorneys for Help Today

Contact Cardamone Law’s Bethlehem Workers’ Compensation attorneys at (267) 651-7945 for a free case evaluation.