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How Are Workers’ Compensation Benefits Calculated in Pennsylvania?

According to Pennsylvania’s workers’ compensation law, you are entitled to certain financial benefits after suffering an injury on the job. This includes financial compensation for the majority of your average salary and any necessary medical costs. Unfortunately, insurance companies do not always handle workers’ comp claims fairly. It is important to understand how much your case is worth. This can allow you to make sure that an insurer is calculating your payout correctly and not taking advantage of you.

Types of Benefits Available

The Pennsylvania Workers’ Compensation Act provides no-fault benefits to a worker who can prove that he or she has an injury or illness that arose out of a function of the job. A successful workers’ compensation claim in Pennsylvania can lead to financial benefits for several types of losses. If the worker qualifies for workers’ comp, he or she can receive a benefits check to cover the following:

  • Medical expenses. Workers’ comp will pay for 100 percent of the injured worker’s reasonable and necessary medical expenses. This can include surgeries, hospital stays, medications, physical therapy and rehabilitation.
  • Partial lost wages. The law entitles an injured worker to recover two-thirds of his or her weekly wage, up to a limit that changes each year. If the calculated amount is less than Pennsylvania’s minimum, it will automatically be increased to the minimum.
  • Disability. There are benefits available for a temporary partial disability, temporary total disability, permanent partial disability or permanent total disability. This award will pay for two-thirds of the difference between what you used to make and what you make now. If you suffered serious disfigurement, loss of a body part, or loss of hearing and vision, you may also qualify for specific loss benefits.
  • Death. If a loved one passed away in a workplace accident in Pennsylvania, you may be eligible for death benefits as a surviving spouse, child or heir. These benefits can pay for partial funeral reimbursement, as well as the value of the decedent’s lost wages until you remarry or your child turns 18.

Upon the receipt of your workers’ compensation insurance claim, the insurance company will investigate the accident and review the proof of losses that you submitted. This will allow the insurer to determine what types of benefits you are eligible to obtain. Then, the insurance company will calculate the value of your claim according to the state’s applicable guidelines.

How an Insurance Company Calculates Benefits

An insurance company will use the victim’s medical records and bills to determine how much it owes for the full value of necessary medical needs. Then, the company will calculate the worker’s lost wage payment by multiplying the employee’s daily wage by the number of days he or she generally works in a full year. Next, the insurer will divide this number by 52 weeks to calculate the average weekly wage. Finally, the employer will calculate two-thirds of this number to determine how much the employee is eligible for in lost wage replacement.

Finally, the insurer will make sure that the amount awarded complies with that year’s maximum wage limits. In 2021, if a worker makes between $627.78 and $847.50, the weekly workers’ compensation rate is $565.00. If the worker makes between $847.51 and $1,695, lost wages are calculated at 66 2/3 percent, up to a maximum of $1,130 per week. If the worker qualifies for any other type of insurance benefit, this amount will be added to the final settlement.

Should You Accept a Workers’ Comp Settlement?

This answer depends on your particular case. Before you accept a workers’ compensation insurance settlement in Pennsylvania, contact an attorney to discuss the fair value of your claim. Once you accept, you cannot go back and renegotiate. You can trust an evaluation you receive from an attorney. If a lawyer believes that you deserve more than an insurance company is offering, he or she can help you negotiate or take your case to trial, if necessary. A lawyer will help you fight for the best possible settlement for your workers’ comp claim.

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