What if I’m never able to return to work after my work injury?
You can theoretically receive workers’ compensation benefits under the Pa WC Act for life as long as you can prove that your work injury prevents you from working. Pennsylvania, for the most part, is a wage loss state for purposes of workers’ compensation benefits meaning if your injury is causing you to suffer a wage loss then you are entitled to workers’ compensation wage loss benefits. Some other states, including New Jersey, only pay you wage replacement benefits for a limited period after which a percentage of impairment is established which results in the payment of one (1) final lump sum, regardless of whether the work injury still prevents you from working. There a two (2) types of wage loss benefits available under the Pa WC Act, temporary total disability benefits and temporary partial disability benefits. Each variety of benefit is referred to as “temporary” because an Employer always has the ability to file a petition challenging your right to continue receiving these benefits, assuming they have sufficient evidence to support the challenge (e.g., an opinion from an IME doctor of full recovery). There is no permanent disability under the Pa WC Act.
Temporary total disability benefits under the Pa WC Act are typically paid at 66 2/3% of your gross weekly pay (there are exceptions to this rule for low and middle income wage earners and, there is a cap or max rate that applies to high wage earners). Total disability benefits are paid as long as the injured worker is completely out-of-work due to their work injury. There is no cap or maximum number of weeks that an injured work can receive total disability benefits. Total disability benefits can be paid for life if the injured worker never recovers from their work injury and, they don’t go back to work in some capacity. Temporary partial disability benefits on the other hand are paid when the injured worker returns to work (either to their regular job or something else) at a wage loss, e.g. earning less than what they did before the work injury. Partial disability benefits are paid at 66 2/3% of the difference between your pre-injury wage and, your current earnings. The maximum compensation rate for the year of the injury is the only limitation imposed on the actual amount of partial disability benefits that you can receive. Otherwise, they are paid at a straight 66 2/3% of the difference between your pre-injury and post-injury earnings. Partial disability benefits are also paid if the Employer establishes through vocational evidence that an injured worker has an earning capacity though they haven’t actually returned to work. This evidence is called a Labor Market Survey (LMS). Partial disability benefits also paid when an Employer has an injured worker undergo an Impairment Rating Examination (IRE), but only after the worker reaches maximum medical improvement or MMI and, the examiner finds the worker less than 50% whole-bodied impaired. The most important distinction between the two (2) types of benefits is that there is a 500 week cap on partial disability benefits. This means that once the status change is made from temporary total to partial under any of the aforementioned circumstances, an injured work can only receive a maximum of 500 weeks of partial disability wage loss benefits. The 500 week period isn’t guaranteed though. The Employer can challenge a worker’s right to receive ongoing partial disability benefits at any time during the 500 weeks to try to suspend the payments or, modify/reduce them. The 500 week period, which is approximately 9 ½ years, is a significant period of time but, as you can see, the 500 week cap is what makes partial disability benefits considerably different than the total disability type that has no cap.