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Which Employees Are Covered by Workers’ Compensation?

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Workers' Compensation in Pennsylvania

If you have been injured on the job or have developed an illness because of a work-related activity, you will qualify for workers’ compensation benefits. A “work injury” is any injury, medical condition or disease that is caused by a person’s job. A work injury can also be an occupational disease or pre-existing condition which is aggravated by the person’s job.

Notice of the injury must be given to the employer within twenty one (21) days after it occurs, or at the latest, within 120 days of the injury. Regardless, you should tell your supervisor immediately after an injury, whether or not you think you require medical care. Employers generally have twenty one (21) days after they receive notice of the injury to either agree that it is work-related or to deny the claim. Before you receive wage losses, you must provide medical proof from a doctor confirming your injuries and whether or not you may return to work, or whether or not there are work restrictions.

Workers’ compensation benefits include compensation for lost wages and medical expenses. Lost wages are usually awarded based on two-thirds of your average weekly wage. (There are, however some exceptions to this rule.) There is no set time limit to receive benefits. However, many employers will try to limit how long a worker can receive benefits. IN general, a person can receive benefits for as long as they are unable to work. In the case of a specific loss award, or when you have suffered a disfigurement or a permanent disability to some part of your body, you can be awarded benefits according to a schedule that determines a specific number of weeks designated for each injury. If you are partially disabled and can return to work with restrictions or limitations, you may still be eligible to receive part-time lost wage benefits and continue to receive medical coverage for your injury.

Workers’ compensation coverage is mandatory for most employers under Pennsylvania law. (There are exceptions to this rule, however these employers may still be subject to lawsuits by employees and to criminal prosecutions.) An employee is anyone who performs services for another for valuable consideration (i.e. money). Although workers’ compensation will cover most workers, there are some exceptions. All businesses which legally employ at least one person are obligated to take part. The workers’ compensation system in Pennsylvania is a “no-fault” insurance system. So, if you are injured at work, it does not matter if it was negligence on the part of your employer or yourself, you are still eligible for workers’ compensation benefits. When you apply for benefits, however, you give up your right to sue your employer. In certain cases, you may, however still sue the party that injured you for pain and suffering.

Am I Eligible for Workers’ Compensation?

To be eligible for workers’ compensation in Pennsylvania, you must meet the four basic requirements to receive benefits.

  • The business you work for must carry workers’ compensation insurance. In Pennsylvania, that is any company or business that employs at least one person.
  • You need to be employed by that company.
  • Any injury or illness you have needs to be work-related.
  • You need to notify your employer of your work-related injury within the state’s deadlines.

Let us look at the above requirements more closely.

1. Your Employer Carries Workers’ Compensation Insurance

As we noted above, any business in Pennsylvania which employs at least one person must purchase workers’ compensation insurance. An employer may can do this in one of two ways — they can use a state fund, or they can buy private insurance. Many large companies will pay for their workers’ compensation insurance on their own, in a practice known as self-insurance.

2. You Are an Employee

Employees do not need to be working on a contract.

In most cases, this is straightforward. Employees do not need to be working on a contract, as workers’ compensation also applies to at-will employees and even casual employees who are performing their employer’s regular business.

For example, if you work a grocery store only a few hours a week, but during those few hours you are performing the employer’s regular business of selling groceries, then you are covered by workers’ compensation.

If you work for a temp or staffing agency, and you were injured while you have been assigned to work with another company or employer, you should still be covered by workers’ compensation. The question of which company will pay for that compensation needs to be answered by the staffing agency and the business where you were assigned.

3. The Injury or Illness Must Be Work-Related

Any time you do anything for the benefit of your employer and suffer an injury, it is considered work-related. It does not have to happen on your actual worksite. If you are making deliveries, attending a work-related function or traveling for a meeting related to your business out of state, you are covered by workers’ compensation.

4. Meeting Deadlines

If your employer participates in the workers’ compensation insurance program, if you are an employee, and if you are injured on the job, you still need to meet your state’s deadlines for reporting that injury. If you do not, you may lose your eligibility to receive workers’ compensation benefits.

It is also essential that you report your injury to the right person. You need to tell your employer, your supervisor or someone like a company nurse that you have been injured. Telling a friend that you got hurt does not qualify as reporting a work-related injury.

What Are the Exceptions to Workers’ Compensation?

An employer in Pennsylvania may not be required to follow workers’ compensation coverage guidelines if all of their employees fall into at least one of the following categories:

  • Employees of the federal government
  • Members of the military or the National Guard
  • Longshoremen, harbor workers or dockworkers
  • Railroad workers
  • Volunteers — although volunteer firefighters are considered eligible for workers’ compensation
  • Casual employees whose job is casual in nature and not a part of the employer’s regular business
  • Domestic workers who have not chosen to work under the provisions of the Workers’ Compensation Act
  • The sole provider of a business or general partners
  • Agricultural laborers who earn under $1,200 during a calendar year
  • Agricultural workers who work less than 30 days per the calendar year
  • A farmer’s spouse or children under the age of 18 — although they can seek inclusion by filing a written contract with the Pennsylvania Department of Labor and Industry
  • People who have been granted religious exemptions
  • Executive officers granted exclusion by the Pennsylvania Department of Labor and Industry
  • Licensed real estate salespersons or associate brokers who work on a commission-only basis and are treated as independent contractors for state or federal tax purposes

Why Are These People Not Covered by Workers’ Compensation?

People in the above categories are not considered employees and are therefore ineligible for workers’ compensation for a variety of reasons:

1. Sole Proprietors and Partners

When you are the only person in your business, you do not have to participate in the workers’ compensation plan. You may, however, decide to be covered as an “employee” if you pay the workers’ comp premiums.

2. Volunteers

Volunteers do not have to be covered by workers’ compensation when they perform nonprofit charitable work. To qualify for this exemption, they cannot be paid by the nonprofit, but they can accept food, lodging or transportation.

Volunteers don't have to be covered by workers' compensation.

As we noted above, this rule does have some exceptions. Workers’ comp covers volunteer firefighters. The same is true of any volunteer who was asked by a firefighter or a police officer to help them in an emergency.

3. Federal Employees

All federal employees, including those who work for the post office, receive coverage through the Federal Employees Compensation Act. Like workers’ compensation, this act covers any industrial injuries or illnesses contracted while at work.

4. Railroad Employees

The Federal Employers Liability Act, known as the Railroad Workers Act, covers railroad workers. The act allows railroad workers not covered by workers’ compensation to sue the railroad company after a work-related accident. The benefits available to railroad workers include payments for lost wages and any medical treatment, and unlike the workers’ compensation system, may include benefits for pain and suffering.

5. Longshoremen

Workers’ compensation for longshoremen and harbor workers is handled by the Longshore and Harbor Workers’ Compensation Act. It covers any injuries or illnesses that occurred on the piers or within the waters of the U.S.

6. Independent Contractors

Anyone who is considered an independent contractor is not eligible for workers’ compensation in Pennsylvania. This includes people such as taxi or rideshare drivers, members of what is known as the “gig” economy or people who work on a commission-only basis.

Independent contractors are not eligible for workers' compensation in PA.

Some of the deciding factors in determining who is qualified as an independent contractor include the use of tools, who directs their work, whether they have been working a long time for the employer, if they perform the employer’s regular business and if the employer takes taxes out of the monies paid to the contractor.

7. Part-Time Workers in Some Occupations

This category includes maids and nannies, but only those who work part-time. The same is true of gardeners or maintenance workers. If you hire someone to cut your grass, for instance, you do not have to pay for workers’ compensation.

8. Agricultural Workers

If you work full-time on a farm, you are eligible for workers’ compensation. If you work less than 30 days a year on a farm — for instance, you are hired only to pick strawberries or harvest corn for a month — or you earn less than $1,200 during a calendar year working on a farm, you are not eligible for workers’ compensation.

What If I Am Injured on The Job, and My Employer Tells Me That I Am Not Eligible for Workers’ Compensation?

Insurance companies will try to find any way to deny or reduce your workers’ compensation benefits. One of the main ways they do this is to classify employees as independent contractors.

A true independent contractor uses their own equipment and tools, does not have the employer take out any taxes, is typically only hired for one job, and is not performing regular business for the employer. If you take our above example of the grocery store, if the store hires someone to paint the walls and they are injured while doing the painting, the grocery store is not responsible for paying for workers’ compensation because painting is not part of the grocery store’s regular business.

True independent contractors make their own hours and are usually highly skilled.

Here is an important distinction. An employer normally does not tell an independent contractor how to do their job. An employer hires a plumber to do a job but then does not stand over them telling them how to do their job. If, however, the employer tells an “independent contractor” what they want them to do and how to do it, then this independent contractor is more like an employee.

Also, if you are an independent contractor who has been doing the same job for one employer for many months or years and you are injured while performing this job, you may be eligible for workers’ compensation.

When Should I Speak to a Lawyer?

If you are injured on the job, and your employer tells you that you cannot file for workers’ compensation benefits because you are an independent contractor, or you fall under any of the other exemptions listed above, and you believe this not to be the case, you should contact an experienced workers’ compensation lawyer as soon as possible.

As we noted above, this is a favorite trick of many insurance companies. You can be working for someone for years and then, if you are injured on the job, suddenly find out that you are considered an independent contractor.

Benefits of an experienced workers' compensation attorney

Trying to fight your employer or their insurance company in these cases can be very difficult on your own, especially if your injury is a serious one, and you are still dealing with the effects of being injured and the stress of not being on the job. An experienced workers’ compensation attorney is familiar with the tactics that employers and their insurance companies try to use to deny workers their legitimate benefits.

The key is not to hesitate. If you believe you have a legitimate right to workers’ compensation benefits, then follow the procedures mentioned above. Report the injury to the proper person at your company. When you seek medical attention, make sure you let the medical personnel know that you were injured on the job. Contact an experienced workers’ compensation lawyer who can advise you on the best way to proceed.

Contact an Experienced an Attorney at KBG Injury Law

When you have been injured on the job, you expect workers’ compensation will help get you through the time you miss at work, giving you continued medical insurance and covering some of your lost compensation. But are you sure you qualify for workers’ comp? A small number of people do not, even though they work 40 hours a week.

If you find yourself in a situation where you need to rely on workers’ compensation, it is vital to know you will be covered. The attorneys at KBG Injury Law can help you determine that eligibility and make sure you receive any benefits to which you are legally entitled.

If you are interested in talking about your case or need help determining if you are eligible for workers’ compensation, we offer a free consultation. You can call us at 1-800-509-1011, or you can visit our contact us page where you can leave us your contact information and tell us about your situation.

During this challenging time, our attorneys are advocating more than ever. While our physical offices are closed, we are all working remotely to ensure you still get the Results You Deserve. To all of our current clients, you can connect with us the same way you always do via email, phone, fax or text. To all of our prospective clients, the best way to get in touch with us is by using our contact form or by calling (800) 509-1011