Most employers in Pennsylvania are required to carry workers’ compensation insurance so injured employees have benefits they can turn to for medical treatment and a portion of their wages while recovering. Workers’ compensation insurance can be expensive, though. So what is the alternative for a Pennsylvania employer who needs coverage but can’t afford it?
In cases like these, employers can turn to the Pennsylvania State Workers’ Insurance Fund (SWIF), a state-run program offering affordable workers’ compensation coverage for employers who need it. If you are injured while working in Pennsylvania, there is a good chance your employer uses the State Workers’ Insurance Fund — especially if you work at a small business.
The Pennsylvania workers’ compensation attorneys at Calhoon & Kaminsky P.C. have helped many injured employees navigate the PA State Workers’ Insurance Fund so they can get the help they need. To learn how the State Workers’ Insurance Fund works or how to apply for benefits after a work-related injury, contact our office for a free consultation.
What Is the Pennsylvania State Workers’ Insurance Fund?
The Pennsylvania Workers’ Compensation Act states that most businesses in the state are required to purchase workers’ compensation insurance. These plans are not always affordable, especially for smaller companies.
To make sure all businesses in the state can take care of their injured workers and avoid non-compliance, the state government created the State Workers’ Insurance Fund. By getting workers’ compensation coverage through SWIF, companies that might otherwise have to shut down or face lawsuits from injured employees can stay in business.
Injured employees benefit from Pennsylvania’s SWIF because they can get the treatment they need and cover their bills through workers’ compensation benefits. Without SWIF, many businesses might have to close, and many injured workers would be unable to pay for their medical bills.
How Does SWIF Workers’ Compensation Coverage and Benefits Work?
The Commonwealth’s Department of Labor and Industry (DLI) discusses the following fundamental questions people may have about workers’ compensation coverage:
- When does coverage start for employers? — Coverage starts the day after the state receives a completed application for coverage and the first insurance premium payment from an employer.
- When does coverage start for employees? — Coverage begins as soon as the employee starts their first day of work.
- What medical benefits are offered for injured employees? — Workers’ compensation benefits through SWIF help injured workers recover as quickly as possible so they can get back to work. SWIF covers appointments with doctors, reasonable surgeries and medical services, hospital treatment, prescriptions, and orthopedic devices.
- What wage-replacement benefits are included? — If your injuries are so severe that you miss seven days of work, you can receive wage-replacement benefits through your employer’s workers’ compensation coverage. The value of these benefits is set at two-thirds of your average weekly wages, up to a limit set by state law. If you are totally disabled, these benefits will continue until you have fully recovered, find work that fits your injuries without any decrease in income, or are medically cleared to return to work without restrictions.
What Does Partial Disability Cover in SWIF?
Besides covering workers who are totally disabled, SWIF also protects employees who are partially disabled due to a work-related injury or illness. These benefits can be challenging to calculate, as they are based on several factors.
The DLI states that injured workers are eligible for partial disability benefits if they return to work but earn less income than before their injury. The value of these benefits is set at two-thirds of the difference between the employee’s pre-injury average wages and their average wages after returning to work. Injured employees cannot receive more in workers’ compensation and wages than they would have earned before their injury. Partial disability benefits are capped at 500 weeks in most cases.
There are two particular kinds of partial disability benefits:
- “Specific loss” benefits — These benefits include payments made when a worker loses a body part, their vision, or their hearing in a work-related injury. How long you can receive these benefits depends on what body part is injured and the extent of your disability.
- Disfigurement benefits — If you are substantially disfigured on your head, neck, or face, you could receive workers’ compensation benefits for up to 275 weeks, depending on the extent of your injuries.
What Is a Work-Related Injury and Occupational Disease?
Generally, an injury that happens at work or while performing a work-related task counts as a work-related injury. However, the DLI has specific definitions of work-related injuries or illnesses.
According to the DLI, work-related injuries include the following:
- Injuries resulting from a specific incident at work
- Injuries from repetitive actions at work
- Pre-existing conditions aggravated by your job
- Previous work-related injuries that cause disabilities later on
The DLI outlines a few specific illnesses that are considered work-related, such as respiratory conditions related to mining or firefighting and diseases such as hepatitis or tuberculosis that healthcare workers often contract.
More broadly, an illness is considered work-related if it meets the following criteria:
- The employee is exposed to the illness because of their job.
- The disease has a causal relationship to the employee’s job.
- The disease is more common in the employee industry than in the general population.
How Do You Get Medical Treatment in SWIF?
The DLI says you must see a medical provider from a list chosen by your employer for the first 90 days after seeking medical treatment. That list must meet certain conditions, including that at least three providers must be physicians. Once 90 days have passed, you can see a doctor of your choice.
Contact Our Pennsylvania Workers’ Compensation Lawyers
If you’ve been injured at work, what you want most is competent medical care and coverage for those vital services. You want to ensure you can get and pay for the benefits you need during this challenging time.
Our knowledgeable workers’ compensation lawyers can help you through this complicated process. We pride ourselves on two decades of assisting loyal workers and their families with their workers’ comp claims. Contact Calhoon & Kaminsky P.C. today to schedule a free consultation.
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For more than 20 years, our attorneys have been helping injured workers navigate the complex Pennsylvania workers’ compensation system. We empower workers with the information and the representation they need to make the best decisions for themselves and their families’ future.
