Magnifying Glass
pennsylvania 40430 640
Back to State Contact Info

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

Read Also

New Hampshire Workers’ Compensation Reference Chart for Adjusters, Produced by AI

Coverage Requirements All employers with one or more employees must carry workers' compensation insurance. Sole proprietors and partners may opt in. Independent contractors are excluded unless misclassified. Employers must post Form WCP-1 visibly at the […]
Massachusetts Workers’ Compensation Reference Chart for Adjusters, Produced by AI

Coverage Requirements All employers must carry workers' compensation insurance for employees, including part-time and seasonal workers. Sole proprietors, partners, and LLC members may opt out. Corporate officers with ≥25% ownership may file Form 153 to […]
Maryland Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

Adjuster EssentialsCore BenefitsClaims HandlingLegal ProcessesCompliance & PenaltiesResources Adjuster Essentials Core Benefits Overview Benefit Type Details Medical Benefits Covers all necessary and reasonable treatment. No co-pays or deductibles Temporary Total Disability (TTD) 2/3 of average weekly […]

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.

More by This Author

Answer Key: Workers’ Compensation Adjuster Training Quiz, Produced by AI

Section 1: Introduction to Workers' Compensation Section 2: Claim Lifecycle Overview Section 3: Medical Benefits & Treatment Guidelines Section 4: Indemnity Benefits Section 5: Legal & Regulatory Compliance Section 6: Communication & Documentation
Workers’ Compensation Adjuster Training Quiz Questions, Produced by AI

Section 1: Introduction to Workers' Compensation Section 2: Claim Lifecycle Overview Section 3: Medical Benefits & Treatment Guidelines Section 4: Indemnity Benefits Section 5: Legal & Regulatory Compliance Section 6: Communication & Documentation
Tech’s Everywhere, but will it Reduce Workers’ Compensation Litigation?

WCI 2025 The whole point of the Grand Bargain is to keep litigation to a minimum and take care of workers with job-related injuries, but anyone who's spent a little time in the industry has […]

Read More

New Hampshire Workers’ Compensation Reference Chart for Adjusters, Produced by AI

Coverage Requirements All employers with one or more employees must carry workers' compensation insurance. Sole proprietors and partners may opt in. Independent contractors are excluded unless misclassified. Employers must post Form WCP-1 visibly at the […]
Massachusetts Workers’ Compensation Reference Chart for Adjusters, Produced by AI

Coverage Requirements All employers must carry workers' compensation insurance for employees, including part-time and seasonal workers. Sole proprietors, partners, and LLC members may opt out. Corporate officers with ≥25% ownership may file Form 153 to […]
Maryland Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

Adjuster EssentialsCore BenefitsClaims HandlingLegal ProcessesCompliance & PenaltiesResources Adjuster Essentials Core Benefits Overview Benefit Type Details Medical Benefits Covers all necessary and reasonable treatment. No co-pays or deductibles Temporary Total Disability (TTD) 2/3 of average weekly […]
New York Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

Adjuster Essentials Core Benefits Overview Benefit Type Details Medical Care Covers all necessary treatment from authorized providers. No out-of-pocket costs. Temporary Disability (TD) Up to 2/3 of average weekly wage, subject to state max (e.g., […]
California Workers’ Compensation Law Reference Chart for Adjusters

Adjuster CertificationCore BenefitsClaims HandlingLegal ProcessesResources Adjuster Certification & Training Core Benefits Overview Benefit Type Key Details Medical Care Must be reasonably necessary to cure or relieve injury. Governed by MTUS. Temporary Disability (TD) Paid when […]
Texas Workers’ Compensation Law Reference Chart for Adjusters, Produced by AI

Category Key Information Governing Law Texas Labor Code, Title 5; 28 TAC Chapters 102–180 Coverage Not mandatory for private employers; those who opt in must notify employees and post notices Injury Reporting Employee must report […]