Workers’ Compensation Insurance Policy & Law in Pennsylvania

How Does Workers’ Compensation Insurance Work in Pennsylvania?

Being a business owner in vibrant Pennsylvania is a big job. However, your amazing business acumen isn’t the only skill needed to protect your bottom line in Pennsylvania. Workers’ compensation insurance can help you protect your most important asset — your people — while also safeguarding you from liability.

The Pennsylvania Workers’ Compensation Law defines workers’ compensation as an insurance system that protects both employees and employers in the event of an on-the-job injury or illness. Employers pay for the employees’ insurance policies to protect those employees from costs related to workplace injuries and illnesses. In exchange for that coverage, employers are protected from being sued by employees in relation to workplace incidents.

Following an injury or illness as a result of their work, employees are eligible to file a workers’ comp claim to receive benefits for:

  • Costs related to emergency and ongoing medical treatment needed to recover from their injury or illness.
  • Lost wages associated with missing work due to a work-related injury or illness.
  • Death benefits in the event the employee dies as a result of their workplace injury or illness.

Employers may be curious about what steps they should take if an employee gets hurt. Laws and requirements may vary from state to state but generally, the process is the same throughout most of the country. After an injury or the diagnosis of an illness, employees should notify their employer of the incident as soon as possible.

Once notified, the employer needs to provide the employee with the required information they need to file a claim. After submitting the claim to the insurer, all parties involved should communicate with the insurer throughout the claims process. If you don’t believe an employee’s claim is valid, talk to your insurance provider to make sure your employee’s injury qualifies as a workplace injury as outlined in your workers’ comp policy. Read more about the workers’ comp claims process here.

Who Needs Workers’ Compensation in Pennsylvania?

In Pennsylvania, the law requires nearly every business to have workers’ comp coverage. Workers’ comp coverage is required for all employees, regardless of whether they are full-time, part-time, or seasonal employees. The only businesses that do not have to have workers’ comp insurance are those that fall under the specific exemptions as set by the law. These exemptions are as follows:

  • Railroad workers
  • Longshoremen
  • Federal employees
  • Domestic servants
  • Some agricultural workers
  • Workers who have exemptions based on religious beliefs or executive status within a corporation

Self-employed individuals — also referred to as sole proprietors — don’t legally have to have workers’ comp coverage. However, those who are self-employed can choose to get coverage for themselves regardless. The benefits that workers’ comp provides can be beneficial to self-employed people and some clients may even require it to book certain contract jobs.

What Does Workers’ Compensation Insurance Cover in Pennsylvania?

Workers’ comp in Pennsylvania covers expenses related to on-the-job injuries or illnesses. The benefits of workers’ comp include:

  • Payments for lost wages that amount to two-thirds of the employee’s average weekly wage, up to a weekly maximum, including total and partial disability benefits
  • Death benefits
  • Specific loss benefits in the event of permanent loss of appendages, loss of hearing, or permanent disfigurement
  • Medical care such as surgical services, medical services, medicine, supplies, hospital treatment, orthopedic care, prostheses, and more

What Do I Risk By Not Having Workers’ Comp Insurance in Pennsylvania?

The state of Pennsylvania takes workers’ compensation very seriously. This means that employers who are legally required to have coverage and are found to be non-compliant may be subject to penalties such as:

  • Being held responsible for reimbursing all costs, interest, penalties, and fees that were paid by the Uninsured Employers Guaranty Fund in relation to the claim
  • Civil or criminal prosecution
  • Misdemeanor convictions resulting in a fine of $2,500 and up to one year in prison for each day the employer is in violation of the workers’ comp law
  • Felony convictions resulting in a fine of $15,000 and up to seven years in prison for each day the employer is in violation of the workers’ comp law

Learn more about workers’ comp coverage requirements in other states here.

What Types of Injuries Are Covered by Pennsylvania Workers’ Comp?

Pennsylvania state law outlines what types of injuries are covered by workers’ comp insurance. The types of injuries that are not typically covered by workers’ comp in Pennsylvania are:

  • Injuries, illnesses, or diseases that are not caused by work
  • Injuries or deaths that are intentionally self-inflicted
  • Injuries, illnesses, or deaths that are caused by an employee’s violation of the law including, but not limited to, the illegal use of drugs and being intoxicated

As is the case with most states, a key aspect of the claims process is ensuring that the injury or illness occurred during the “scope and course” of an employee’s work. For more information about the workers’ comp claim process, visit our learning center.

What Are Workers’ Comp Death Benefits in Pennsylvania?

In the event that a worker passes away as a result of a work-related injury or illness, their dependents may be eligible for death benefits, including burial and funeral expenses up to $7,000 and lost wages. Dependents include:

  • A spouse
  • A child under 18
  • A child who is a full-time student up to age 23
  • A child of any age who is physically or mentally incapacitated
  • Any parents who are dependent on the deceased person for financial support
  • Any siblings under the age of 18 who are dependent on the deceased worker for financial support
  • Any siblings who are full-time students, and who are dependent on the deceased worker for financial support, up to age 23

How Do Workers’ Comp Settlements Work in Pennsylvania?

As in the case of other states, workers’ comp settlements in Pennsylvania are mutually beneficial agreements made between the injured worker, their employer, and the insurance company that closes the workers’ comp claim. These agreements pay an agreed-upon amount of compensation via structured monthly payments or one lump sum to the injured worker. In exchange, the worker agrees not to pursue additional benefits or civil litigation in relation to the claim in the future, and the claim is closed permanently.

What Are the Statutes of Limitations Regarding Workers’ Comp in Pennsylvania?

In Pennsylvania, employees must file their workers’ comp claim within three years of the date of the injury or diagnosis of the illness. In addition, the injured employee must see an approved healthcare provider within 90 days of their injury and inform their employer of the injury within 120 days.

Many factors unique to your business will be utilized to determine your exact insurance premiums.

Some of these factors include:

  • The location of your business
  • The size of your business and the number of employees
  • The industry in which your business operates
  • The claims history of your business

Hoping to lower your premiums? Taking preventative steps, such as prioritizing risk mitigation techniques, might help. Insurance providers value how seriously businesses take workplace safety when calculating workers’ comp premium rates. This means that by taking simple steps such as enacting employee training sessions, following industry best practices, and creating safety protocols, you could potentially help lower your insurance premiums.

In addition to these steps, in the state of Pennsylvania, any employer that maintains a workplace safety committee certified by the state can receive a 5% discount on workers’ compensation policy premiums.

How Do I Get Workers’ Comp for My Pennsylvania Business?

Employers looking for coverage in Pennsylvania can purchase a policy through any private insurance company, agent, or broker that is licensed to operate in the state or through the State Workers’ Insurance Fund.

Pennsylvania businesses can also apply to self-insure, which means that they are held financially responsible for the cost of all claims and related expenses without the assistance of insurance. This is not an ideal choice for many businesses, as it is costly in the event of an incident. Luckily, getting workers’ comp coverage in Pennsylvania is easy with the right private insurance provider.

What Cities Can I Get Workers’ Comp For My Pennsylvania Business?

We offer workers’ compensation to businesses no matter where you are in Pennsylvania. If you are in the Poconos, Lehigh Valley or working in Western Pennsylvania we can help you protect your employees.

If you need workers’ comp coverage for your Pennsylvania business, you can purchase a policy through any private insurance company, agent, or broker that is licensed to operate in the state of Pennsylvania. So even if you aren’t in any of the following cities, know that we can still help you:

  • Allentown
  • Philadelphia
  • Pittsburgh
  • Reading
  • Scranton

Hassle-free Workers’ Comp Insurance For Your Pennsylvania Business

Cerity offers a faster, more affordable way to get workers’ comp. Our goal is to help Pennsylvania business owners like you get insurance premium quotes easier than ever before. We know what a hassle phone calls with insurers and complicated processes can be. That’s why we combined proprietary tools and modern technology to provide business owners with quick quotes and instant policies. Simply log on, tell us a bit about your business, and get a quote quickly and easily.

To get workers’ compensation insurance, visit our free online quote tool and see how easy it is to protect your Pennsylvania business today.

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The information provided is intended to provide a general overview. This information is not legal advice and should not be relied on as such. Cerity® makes no warranties for the accuracy, adequacy, or completeness of the information provided, and will not be responsible for any actions taken based on the information contained herein. If you have legal questions or need legal advice, please consult an attorney.