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Pennsylvania workers’ compensation claims and the captive period

On Behalf of | Mar 6, 2020 | workers' compensation |

Enacted in 1915, the Pennsylvania Workers’ Compensation Act protects employees and employers.  

If you experience a work-related injury, you will receive medical treatment free of cost and compensation for lost wages. Workers’ compensation coverage is a requirement for most Pennsylvania employers, but injured workers cannot sue employers that possess the proper coverage. 

Who is an employee under Pennsylvania law? 

Pennsylvania law dictates that an individual who performs services for another individual in exchange for money is an employee. Workers excluded from this definition are casual and domestic workers. You are eligible to receive coverage for injuries sustained while you are performing duties on behalf of your employer as long as you follow the state’s workers’ compensation guidelines. 

What is the captive period in a workers’ compensation claim? 

After an injury, you must notify your employer of the circumstances surrounding the incident within 21 days. Rejection is possible if you do not make the notification within 120 days. You must then visit a doctor to diagnose the extent of the injury. 

Pennsylvania workers’ compensation law has a captive period that dictates which doctors you may visit and when. You must visit a doctor or medical facility on your employer’s coverage for the first three months after the injury. Ninety days is the captive period of the claim. 

You may visit a doctor not covered by your employer’s coverage after three months. However, there is no mandate that the workers’ compensation insurance must cover those costs. Other options may be available to cover medical expenses. 

What happens after I inform my employer of the injury? 

Your employer and the workers’ compensation insurer will review your injury claim within 21 days of notification. Your employer will then deny or accept your claim. 

You will receive regular payments equal to two-thirds of your weekly salary after approval of the claim. You are eligible to receive compensation for your entire employment period. Coverage begins on your first day of employment.