Find the Answers to Your Pennsylvania Workers’ Compensation and Disability Benefits Questions
Most people navigating the workers’ compensation and disability benefits application processes come to us with questions and confusion. Here, we share some of the questions that we answer most about the disability and workers’ compensation application and appeals processes. If you have a question for us, check out this page to see if we have answered this question for others!
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How long do you have to be out of work to get workman's compensation?
Under Pennsylvania law, your disability must last more than 7 days for you to be entitled to receive wage loss benefits. You need not be completely out of work. If you are working light duty as a result of your work injury and you are earning less than your pre-injury wages, you are entitled to receive benefits.
I'm a member of Teamsters Local 500 in Philadelphia and I've suffered a work injury. Who are the best attorneys to represent me?
The Boles Firm provides representation to Teamsters 500 members at a discounted rate. We have have been representing unionized employees for decades, and Mr. Boles has read and interpreted hundreds of collective bargaining agreements over the years to determine the impact that work injuries have on union rights. If you are a member of Teamsters 500, and you suffer a work injury, call The Boles Firm now.
I am a Philadelphia based employee of American Airlines and suffered an Injury On Duty (IOD). Who has experience representing AA employees?
The Boles Firm has been representing flight attendants and flight personnel for two decades in connection with Injured On Duty (IOD) claims. We have a special page for American Airlines flight attendants who have suffered injuries which can be accessed here. We also represent pilots and ground personnel. Because we know the doctors AA uses, the insurance company, and your pension and union rights, we have a decisive edge over all firms practicing Pennsylvania workers' compensation.
I work for Bayada. What lawyers should I get to help me if I suffer a work injury?
At The Boles Firm, we have represented nurses, certified nursing assistants, physical therapists, pulmonary therapists and other medical personnel for over 30 years. Mr. Boles is the author of A Safety Guide for Pennsylvania Nurses and other books on safety, the rights of the disabled, and Pennsylvania workers' compensation. Medical personnel work in one of the most dangerous of careers, and having an attorney knowledgeable about those dangers may mean the difference between winning and losing your case.
How do I find out the name, address and telephone number of the workers' comp insurance company for my employer?
If your employer will not give you this information, your claim may be delayed. If despite repeated requests you can't get this information, go to this page, where you can get the name, address and telephone number for your employer's workers' compensation insurance company.
What is a mediation?
A mediation is a proceeding in which a judge who is not going to decide your case attempts to resolve the case via negotiation. Everything that occurs in a mediation is kept strictly confidential by the judge presiding. Information provided to the judge by one side will not be shared with the other side unless the judge has permission to do so. If the case does not settle, the presiding judge does not let the judge who will decide the case know what occurred in the mediation, other than to let the judge know that the parties were unable to reach a resolution.
In general, mediations are attempts to resolve some or all of the parts of a workers' compensation case in exchange for the payment of a set amount of money that is determined during negotiations between the parties. The negotiations to resolve a case may begin long before a mediation. The process ordinarily occurs with the claimant's attorney issuing a demand to resolve the case, with the defendant responding, if at all, with a significantly lower number. The parties will often go back and forth until an amount acceptable to all sides is accepted or the parties are unable to reach agreement.
There may be other issues that are important to consider in the settlement of a workers' compensation case. I discussed some of these issues in my book, The Wounded Worker: Inside the Pennsylvania Workers' Comp Maze. I also discuss these issues in another article, which you can read by clicking here.
My doctor has released me to light duty, but my employer does not have light duty. What should I do?
You do not have any obligation to do anything. If your employer offers you light duty, you may have an obligation to make a good faith effort to follow through on the offer of employment. But be wary. Click here for a discussion of some of the things that might go wrong.
I’ve suffered a Pennsylvania work injury, and it’s my understanding that I have to treat with a company doctor. My employer won’t tell me where to treat or return my calls. What should I do?
Very few people really have an obligation to treat with a company doctor. Unless your employer complies with the law and regulations governing treatment by a company doctor, you are free to treat with a physician or medical provider of your choice. You can go to any physician or medical provider if your employer fails to return your calls. You can also get in touch with the insurance company directly to report your claim and request information. To find out the name, address and phone number of your employer's workers' comp insurance company, click here.
How do I calculate my Pennsylvania workers' compensation benefits?
Workers' compensation wage loss ("indemnity") benefits are calculated by analyzing the wages you received during the 52 calendar weeks before your work injury. If you were employed by more than one employer on the date of injury, you are entitled to receive benefits based on wages that you were receiving from all employers. If you have any questions concerning the method by which your employer calculated your compensation benefits, call The Boles Firm and we will provide you with a free calculation of your benefit rate.
When you begin receiving benefits, you are supposed to receive a Statement of Wages that describes how your Average Weekly Wage (AWW) was calculated. As you can see by clicking on the link for the Statement of Wages form, if your gross (before tax) wages are fixed by the week, this wage plus gross weekly board/lodging, federally reported gratuities, annual bonus, incentive or vacation pay is your Average Weekly Wage under the Pennsylvania Worker’s Comp Act. Because board/lodging, vacation pay, bonus and incentive pay are the most frequent source of errors in Statements of Wages, be careful to double-check these calculations!
If your wages vary from week to week, you must gather your paystubs for the 52 weeks before your work injury occurred to calculate your benefits. If you do not have your paystubs, ask for a printout from the personnel office of your employer.
To determine your weekly benefit, you must divide the 52 calendar weeks that preceded your work injury into four 13 week periods and add up the gross wages you earned during each 13 week period. Make sure you use the pay period covered by your paycheck (which should be stated on your paystub) and not the day your employer issued the check.
If you are paid every two weeks, this presents a slight problem: when calculating the total gross wages you earned for a particular 13 week period, the last pay stub in each period will overlap with the next period. You handle this by dividing by two the gross wages earned during the two weeks that run from one period into the first week of the next period and. Assign one half of your gross wages for this two week period to period one, and half to period two.
Let's give an example. Assume your injury occurred on March 31, 2016 and you work Monday to Friday. The four 13 week periods preceding the date of injury are as follows:
First period 3/29/2015 – 6/27/2015
Section period 6/28/2015 – 9/26/2015
Third period 9/27/2015 – 12/26/2015
Fourth period 12/27/2016 – 3/26/2016
Let's assume you are paid biweekly gross wages ranging from $1,520.00 to $1,650.00. Let's further assume for the pay period ended October 2, 2015, you earned $1,620.00. The two week pay period ended October 2, 2015 does not match any of the four periods that set forth above. Handle this by dividing the amount you received for that 2 week period, $1,620.00, in two, yielding $810.00. Assuming you earned $1,580.00 for every 2 week period ended through September 18, 2015, your total pay for the second period would be $10,290.00. When you divide $10,290.00 by 13 you get your average weekly wage for period two, $791.54. This procedure must be followed for each of the four periods.
First period 3/29/2015 – 6/27/2015 $10,290 ÷ 13= $791.54
Second period 6/28/2015 – 9/26/2015 $11,300 ÷ 13= $869.23
Third period 9/27/2015 – 12/26/2015 $12,100 ÷ 13= $930.77
Fourth period 12/27/2016 – 3/26/2016 $ 9,700 ÷ 13= $746.15
Annual Bonus and Vacation $ 1,400 ÷ 52 = $ 26.92
To calculate your AWW and compensation rate, you must take the sum of the highest three period weekly averages, and divide by three. Divide by 52 the total amount of any annual bonus, incentive or vacation pay you received during the year before the injury and add that to the weekly wage. In our example, This yields an AWW of $890.77 ($791.54 + $869.23 + $ 930.77 = $2,591.54/3 = $863.85 + $26.92 = $890.77) for the year. If you worked more than one job, you must do the same calculation for each and add them together.
If you haven't worked for the employer for at least three consecutive periods of 13 calendar weeks in the 52 weeks preceding the injury, the same calculations are done but only for completed 13 week periods. You then average any completed 13 week periods to get your AWW.
If you've worked less than a complete period of 13 weeks and you don't have a fixed hourly wage, your AWW consists of your hourly wage times the number of hours you were expected to work per week under the terms of your employment. You must add to that your annual bonus, incentive or vacation pay divided by 52.
These calculations will cover most situations. There are some other more unusual situations in which you should almost certainly consult an attorney, including when you are working a seasonal occupation or worked less than 13 weeks for the employer.
Once you calculate your AWW, you must determine your weekly benefit (compensation rate). For most people, this will be tax free benefits equal to two-thirds of your AWW. In our example, the weekly benefit that will be paid is $593.85. For individuals who have low wages, the compensation rate may well be different, and there is a maximum rate you can receive no matter how high your wages were.
If you click here, it will take you to the Pennsylvania Bureau of Worker's Compensation's compensation rate schedule page. Click on the year your injury occurred, and the rate schedule will appear. In our example, the injury occurred during calendar year 2016. For people earning $733.51 or more, the compensation rate is their AWW multiplied by .667, though their benefit rate may not exceed $978, the maximum for 2016. For individuals earning between $489.00 and $733.50 in gross weekly wages, the compensation rate is $543.33. For individuals earning $543.32 or less per week, the compensation rate is .9 times the AWW. The AWW and Compenpensation Rate will appear on the Notice of Temporary Compensation Payable (NTCP) or the Notice of Compensation Payable (NCP).
What's included in calculating my Average Weekly Wage (AWW)?• Wages received from all concurrent employment are used to determine the AWW. If you work for more than one employer, your AWW should be calculated for each job and then added together. Any additional job must be one you have at the time of injury.• Earnings must come from an employment relationship and wages received as an independent contractor are not included.• Overtime pay may not be eliminated in determining your pre-injury AWW.• If you were expected to work overtime but suffer a work injury before a 13 week period has ended, the overtime pay you would have earned had you not suffered the injury is to be included in the calculation of the AWW.• Gross wages include gratuities and board and lodging received from the employer. Gratuities can be included in wages only if reported by the employee for federal income tax purposes. Money advanced to reimburse an employee for board and lodging is to be included in computing the AWW even if they are not included in the employee's federal income tax return.• Bonuses, incentive and vacation pay are to be pro-rated over the year and added to the AWW after the annual amount is divided by 52.• Supplemental unemployment benefits paid pursuant to a collective bargaining agreement are included in the AWW.• Profit-sharing payments may be wages for purposes of calculating the AWW.• Exercised stock options may constitute wages for purpose of calculating the AWW.• Fringe benefits are not included in wages.• Unemployment compensation benefits are not included.• Commissions earned by an employee for the part-time sale of real estate are not added to earnings from the employer liable for payment compensation if the sales person qualifies as an independent contractor for state or federal tax purposes.• Veterans and Social Security benefits are not wages.• Flex dollars provided by the employer for an employee to use to pay the cost of medical and dental benefits are health and welfare benefits and are not included in the calculation of the AWW.• Volunteer emergency workers, including members of volunteer fire departments, are employees and have an irrebuttable presumption that their wages are at least equal to the statewide average weekly wage.• If an employee missed time from work and received workers' compensation benefits for a prior work-related injury during the 52 weeks prior to the most recent disabling injury, the AWW of the employee for the first injury is to be included as earnings when calculating the AWW for the second injury.
There are many ways a workers' compensation insurance company can cheat you if you do not pay attention, but there are remedies available if you are not being paid properly. If you'd like an insider's view of the Pennsylvania workers' compensation system, download a free copy of The Wounded Worker: Inside the Pennsylvania Workers' Comp Maze.