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Pennsylvania Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

26 Aug, 2025 Frank Ferreri

pennsylvania 40430 640
                               

Legal Foundation

  • Governing Law: Pennsylvania Workers’ Compensation Act
  • Administered By: PA Department of Labor & Industry – Bureau of Workers’ Compensation

Coverage & Eligibility

CategoryDetails
Who is CoveredMost employees, including full-time, part-time, and seasonal workers
ExclusionsIndependent contractors, casual employees, certain agricultural/domestic workers
Notice RequirementInjury must be reported to employer within 120 days
Statute of LimitationsClaim must be filed within 3 years of injury

Types of Injuries Covered

Injury TypeExamples
Physical InjuriesFalls, machinery accidents, burns, fractures
Occupational DiseasesRespiratory conditions, hearing loss, toxic exposure
Mental ConditionsCovered if linked to physical injury or workplace stress

Benefits Available

Benefit TypeDetails
Medical BenefitsCovers all reasonable and necessary treatment; first 90 days must use panel providers
Wage Loss BenefitsTwo-thirds of average weekly wage (AWW); subject to annual max
Temporary Total Disability (TTD)Full wage loss if unable to work
Partial Disability (PD)Up to 500 weeks if earning less due to injury
Specific Loss BenefitsFor permanent loss of body parts or senses
Death BenefitsFuneral expenses + support for dependents

Claims Process

StepAction
1. Injury OccursWorker reports to employer
2. Employer ReportsEmployer notifies insurer
3. Adjuster InvestigationInterviews, medical review, surveillance
4. Claim DecisionAccept or deny claim
5. If DeniedWorker may file petition with Bureau of Workers’ Compensation

Litigation & Appeals

StageDetails
Initial HearingWorkers’ Compensation Judge reviews evidence
AppealsTo WC Appeal Board → Commonwealth Court → PA Supreme Court
IME & URIndependent Medical Exams and Utilization Reviews used to challenge ongoing benefits

Adjuster Responsibilities

TaskDetails
Claim EvaluationDetermine compensability, gather evidence
Medical OversightApprove treatment, monitor recovery
Cost ManagementSurveillance, IMEs, settlement offers
CommunicationMay contact injured worker for statements; legal counsel recommended

Common Defenses & Denials

DefenseExplanation
Not Work-RelatedInjury not arising from employment duties
Violation of LawInjury during illegal activity or intoxication
Failure to NotifyLate reporting beyond 120 days
Independent ContractorMisclassification issues

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About The Author

  • Frank Ferreri

    Frank Ferreri, M.A., J.D. covers workers' compensation legal issues. He has published books, articles, and other material on multiple areas of employment, insurance, and disability law. Frank received his master's degree from the University of South Florida and juris doctor from the University of Florida Levin College of Law. Frank encourages everyone to consider helping out the Kind Souls Foundation and Kids' Chance of America.

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