Workers’ Compensation Insurance in Pennsylvania: Coverage, Cost, and Benefits

When you suffer a workplace injury, one of your first concerns is often how to cover medical bills and lost wages. Medical expenses can add up quickly, and time away from work typically means a loss of income. That’s why workers’ compensation insurance exists. In Pennsylvania, this system is designed to provide injured employees with medical coverage and wage replacement, while also protecting employers from lawsuits related to workplace accidents.

If you’ve been hurt on the job, it’s important to understand the basics of Pennsylvania workers’ compensation insurance: what it covers, how it’s provided, and how the claims process works.

What Does Workers’ Compensation Insurance Cover in Pennsylvania?

In Pennsylvania, nearly all employers are required to carry workers’ compensation insurance. This coverage applies regardless of who caused the injury—you do not need to prove fault to receive benefits.

Workers’ compensation benefits typically include:

• Medical expenses – All reasonable and necessary treatment related to the injury, such as hospital visits, surgeries, prescriptions, and rehabilitation.
• Lost wages – If you miss more than seven days of work, you may be entitled to wage-loss benefits. This is generally two-thirds of your average weekly wage, calculated based on your earnings at the time of injury.
• Specific loss benefits – Compensation may be available for permanent loss of use of a body part, hearing, or vision.
• Death benefits – Surviving dependents of an employee who dies from a job-related injury or illness may receive financial support.

For many injured workers, these benefits are a lifeline. The duration and amount of benefits depend on the severity of the injury, the need for medical care, and the extent of disability. Unfortunately, denials, delays, and disputes are common, making legal guidance critical.

Who Provides Workers’ Compensation Insurance in Pennsylvania?

All Pennsylvania employers with at least one employee must maintain workers’ compensation coverage. Failure to do so can result in penalties, fines, and even criminal charges. Employers can secure insurance in four main ways:

1. Private Insurance Carriers – Many employers purchase policies from licensed insurers. These companies process claims and issue payments, but they also have financial incentives to limit payouts. The Consumer Guide to Workers’ Compensation Insurance can help businesses select the right coverage.
2. Self-Insurance – Large employers may apply to self-insure, directly paying benefits rather than purchasing coverage. To qualify, they must prove financial stability and set aside funds to cover claims.
3. State Workers’ Insurance Fund (SWIF) – Pennsylvania operates its own state-run fund, serving as an insurer of last resort for employers unable to find coverage elsewhere.

Regardless of the provider, the benefits available to injured workers are set by Pennsylvania law. However, the claims process may feel very different depending on the insurer involved. Our experienced attorneys at Stern & Cohen can help you navigate these complexities.

How Does the Workers’ Compensation Process Work?

Once an employer secures workers’ compensation insurance, employees are covered from their first day on the job.

The most important step after an injury is notifying your employer. In Pennsylvania, you must report your injury within 120 days, but reporting promptly strengthens your claim.

From there, the process generally follows these steps:

1. The employer reports the injury to their insurance carrier.
2. The insurance company investigates the claim.
3. The carrier either accepts the claim (and benefits begin) or denies it.

Common reasons for denial include:

• Late reporting of the injury.
• Disputes over whether the injury was work-related.
• Insufficient medical documentation.

It’s crucial to remember: the insurance company represents your employer, not you. Many injured workers choose to hire an attorney to ensure their rights are protected and their benefits are secured.

Final Thoughts

Workers’ compensation insurance in Pennsylvania is designed to provide peace of mind. For employees, it ensures access to medical care and wage replacement after a work-related injury. For employers, it offers protection from lawsuits.

In reality, the process is not always straightforward. Claims are often denied or delayed, leaving workers without the support they need.

If you or a loved one has been injured at work, understanding how coverage works—and who provides it—can help you navigate the system. If your claim has been denied or delayed, legal support may be the key to obtaining the benefits you deserve.

Call the attorneys at Stern & Cohen today for a free consultation.