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Pennsylvania workers’ compensation is a valuable resource for those who are injured in a work-related accident or develop an illness. Most employees working for companies in the Commonwealth will qualify for coverage, but it’s important to be aware of the factors that determine workers’ compensation eligibility. 

The basic requirements to qualify for workers’ compensation are that you are a current employee of a company that provides this coverage and you are hurt or made sick while performing your job-related duties. Although these requirements may seem straightforward, they can be more complicated than you realize. A workers’ compensation attorney can examine important considerations to shed some light on whether your unique situation is covered.

Overview of Workers’ Compensation 

In Pennsylvania, employees are protected under the Pennsylvania Workmen’s Compensation Act. This law describes the process of receiving benefits after job injuries, appealing claims, and the kinds of benefits workers are eligible to collect. Workers’ compensation usually provides payments for partial lost wages, medical care, and job retraining.  

Pennsylvania requires nearly all employers with more than one employee to carry workers’ compensation insurance. If your company doesn’t have this coverage, they must self-insure or face fines, criminal penalties, and potential civil lawsuits for this violation. Employees are fully covered even if they have had past claims at previous employers. They can make use of workers’ comp from their first day of work. 

 

While this insurance is available to you, filing claims and ensuring your injury is eligible can be confusing. It’s a smart move to speak with a skilled workers’ compensation attorney during a free consultation to ask questions before proceeding. A reputable lawyer can help you avoid problems with filing a claim and appealing any denials. They can also ensure you get the full benefits you deserve.

Basic Requirements for Workers’ Comp Eligibility

Workers’ compensation is a no-fault system. That means that as long as you were injured doing a work activity, even if it was not on work property, you can still get benefits.

This broad definition means that most workers in Pennsylvania will qualify for workers’ compensation benefits if they are injured at work or while doing something that benefits their employer.

In general, you meet the requirements for workers’ compensation if you meet the following conditions:

• You are an employee of the company.
• Your employer has workers’ compensation insurance (or is supposed to have it).
• Your illness or injury is work-related.
• You meet the required deadlines to report the incident and file a workers’ compensation claim.

Most employers in Pennsylvania are required to carry workers’ compensation insurance. That means that the vast majority of workers should have this benefit available to them if they are injured at work.

Who Qualifies for Workers’ Compensation?

If you are an employee, then you will be eligible for workers’ comp benefits even as early as your first day on the job. As long as your employer has workers’ comp insurance (or is supposed to have it according to Pennsylvania workers’ comp law), then you can get benefits.

This also applies to:

• Seasonal workers
• Temporary employees
• Part-time workers

Many part-time employees make the mistake of assuming that they do not get benefits like workers’ compensation simply because they are not employed full-time. While other benefits may not be available to you as a part-time worker, Pennsylvania laws have determined that workers’ compensation benefits are so essential that virtually all workers should receive them.

Who Is Not Eligible for Workers’ Comp Coverage?

The only workers who are not eligible are those who are considered independent contractors, freelancers, or consultants. However, sometimes employers attempt to classify workers in this way to avoid paying benefits like workers’ compensation. You may still be entitled to benefits even if your employer calls you an independent contractor on paper.

Some employees and industries do not require employers to have workers’ compensation insurance. However, all employees must be considered exempt for an employer to avoid having work comp insurance. Those situations are rare and include examples such as:

• Agricultural employees who work less than 30 days or earn less than $1,200 in a year
• Federal government employees, railroad workers, and longshoremen who are covered under other insurance acts
• Most domestic workers

What Qualifies for Workers’ Comp?

If you are injured at work, you can likely get workers’ compensation benefits. In fact, you do not even have to be on your employer’s property to get work benefits. Workers’ compensation qualifications are broad. If you were doing work on behalf of your employer at the time of the injury, you are likely covered.

Workers’ compensation applies to:

• Acute work injuries
• Gradual or repetitive stress injuries
• Mental injuries or impairments
• Work illnesses

If you believe your injury may be work-related, it is certainly worth asking a Pennsylvania workers’ comp attorney.

Report Your Workers’ Compensation Claim on Time to Be Eligible

As an employee, you have to get your employer notice of an injury within 21 days of the date it occurs if you want retroactive benefits.

You must provide notice within 120 days of the date of the injury. If you do not meet the 120-day deadline, then you may forfeit your ability to get workers’ compensation benefits at all.

Am I Eligible for Workers’ Compensation?

In many cases, your eligibility for worker’s comp benefits is straightforward and clear. However, if you are unsure, you can ask yourself the following questions to help determine if you should be seeking workers’ compensation benefits:

 

• Did my injury arise at work?
• Was I doing an activity that benefited my employer at the time the incident occurred?
• Do I need to see a doctor to address my injury?
• Did my injury occur over time, but it resulted from repeated actions or exposure at work?
• Did I report my injury to my employer within 120 days of when it occurred?

If you said yes to any of these questions, you should investigate your rights to workers’ compensation benefits a bit further. If you want to dig a little bit deeper, you can try our workers’ compensation eligibility quiz.

Reasons You May Not Be Eligible for Workers’ Compensation

Although nearly every employee is covered for nearly any work-related injury or illness, there are some conditions that could nullify your eligibility to file a workers’ compensation claim. If your employer discovers evidence that you failed to follow safety guidelines or violated company policies, your claim may be denied. 

For example, you could be ineligible if any of the following situations apply:

• You did not observe correct safety measures or energy lockout procedures.
• You engaged in dangerous or unlawful actions.
• You inflicted your injury or hazardous exposure on yourself.
• You or the person responsible for the injury or illness were not on company time when it happened.
• You were hurt as a result of fighting or other intentionally harmful actions. 
• You were under the influence of drugs or alcohol when you caused the accident.

If you hurt yourself or were injured by another worker in any of these circumstances, your claim is likely not eligible for worker’s compensation benefits. You can speak with a competent workers’ comp lawyer in Pennsylvania to determine whether you have other legal options to seek financial relief for your injuries. 

We Can Help You Determine Your Workers’ Comp Eligibility

At Krasno, Krasno & Onwudinjo, our team is dedicated to helping workers understand their rights and the benefits they’re eligible to receive. We offer free consultations to discuss your situation and will provide our best assessment of your options. We also work on a contingency basis, meaning you do not pay us unless we reach a settlement agreement for your benefits.

Our team will negotiate with the insurance company to ensure you get the benefits you deserve and push back when they try to reduce or deny your payments. Schedule a free case evaluation with a qualified Pennsylvania workers’ compensation attorney using our online form today.