The purpose of the Workers' Compensation Act (the "WCA") is to provide benefits for employees who suffer job-related disabilities, injuries or death. Similarly, the Occupational Disease Act (the "ODA") covers workers whom suffer disabilities or death from specified occupational diseases (associated with certain toxic chemicals and asbestosis) acquired in the course of their employment. The WCA and ODA will be collectively referred to as the WCA in this article .
The intent of the WCA is to protect employees by providing compensation for work-related injuries and illnesses. The most common benefits include payments for lost wages and health care expenses. The WCA is also designed to be a compromise between the competing interests of the employee and employer. Under the WCA, the employee is forced to give up the right to litigate claims against the employer for injuries to the employee as a result of the employer=s negligence. In turn, the employer insures the employee for virtually all injuries while at work, even the injury is caused by the employee's own negligence, by a co-worker's negligence or by an "act of god".
A person is usually considered an employee under the WCA when another, the "employer", has the right to: (1) hire the employee; (2) fire the employee; and (3) direct both what work is done and the manner in which such work is performed. However, some workers are exempt from WCA coverage, including: home workers and people given unsupervised work to do off-premises; domestic servants; home health aides; agricultural workers; occasional, casual employees; and self-insured persons.
An employer's liability for an employee's injuries is covered exclusively by the WCA. Thus, in most instances the WCA is the only means of compensation for an employee who is injured or killed on the job. However, the Pennsylvania Supreme Court recently issued an opinion that changed the law so that now an employee may file claims against an employer for abuse of process and defamation. Also, if an employer fails to comply with the requirement to purchase insurance, an employee also has the option of filing a claim under the WCA or through a normal lawsuit for negligence. Also, if a "third party" (not the employer or a co-worker) causes the work injury, in addition to WCA benefits, the worker may often make claims against the third party. For example, a separate lawsuit may be filed if a worker is injured when a scaffold set-up by another company fails or when a motor vehicle collision occurs.
The WCA refers to a work-related injury or death as being a "compensable condition". While death is self-explanatory, the term injury is broadly defined to include all work-related harm (except intentionally self-inflicted injuries) and any hurtful or damaging effect which may be suffered. Death is compensable when it is the result of an injury that arises in the course of employment, is related to the work and occurs within three hundred weeks after the injury.
The primary requirement under the WCA is that the employee's injury arose in the course of employment and a relationship existed between the employee's work and the injury. "In the course of employment" is defined to include injuries sustained whenever an employee is furthering the interests of the employer regardless of whether the employee is physically present upon the work premises. It also includes injuries on an employer's business premises due to a defective or dangerous condition.
There is no requirement under the WCA that an injury actually take place on the employer's business premises. Generally, as long as the area where the employee was injured is reasonably connected to the workplace, the injury will be compensable. Of course, the location where the employer directs the employee to do work is considered to be on the employer's business premises. However, for the WCA, an employer's business premises may also include parking lots, private roadways, entrances and exits, common areas and elevators. The WCA also applies to any Pennsylvania worker injured "out-of-state".
In some instances, the nature of employment is such that no employer business premises exists with which to identify the employee. This includes "traveling" or "roving" employees whom work at a number of constantly changing locations. Door-to-door sales and delivery persons are examples of "roving/traveling" employees. Then primary focus is whether the employee was furthering the business interests or affairs of their employer when the injury occurred. If so, the injury is compensable.
For "stationary" employees the act of traveling to and back from work does not further the employer=s business interests. Therefore, injuries occurring during that time period are not compensable. Exceptions do exists, however, for employees who have contracts which include transportation to and from work, or if the employee does not have a fixed place of work or is on a special mission for the employer.
Injuries sustained by an employee operating a motor vehicle owned by the employer and not while the employee is otherwise engaged in the course of employment at the time of injury are specifically excluded from being a compensable injury.
The WCA also does not mandate that the employee be on the clock when the injury occurred. In many instances it is enough that the injury occurred within a reasonable time either before or after the scheduled hours of work. Also a compensable injury may also occur while the employee is involved with an employer sponsored athletic event, social function or other after-work related activity. The focus is whether the employee was performing some activity to promote his employer's business interests or affairs.
It is generally considered that an employee is off the clock whenever the employer's business premises is left during a break for meals. Thus, an injury occurring during a trip to the local fast food restaurant will generally be considered non-compensable. However, business lunches and dinners where the employer's business affairs are discussed will often be considered compensable as the employee is furthering the business interests of the employer.
There are instances that an employee may be "on the clock" and "on the employer's business premises" but still not be covered under the WCA, making the injury non-compensable. This situation is referred to as an abandonment of the course of employment. As long as there is some reasonable amount of connection between the employer's business interests and the injury, the injury will be compensated.
In pursuing WCA benefits, the general rule of thumb is that medical testimony is necessary to prove an injury is connected to work. Also, medical testimony will usually be required to describe the extent of the injury, the prognosis of recovery and whether the employee is able to continue to work "light duty". Therefore, at some point the employee's doctor will be asked to provide a report on the cause of the injury, the prognosis for recovery and treatments necessary to address the injury. Without solid medical testimony by a physician, an employee will usually not be justly compensated for their injuries.
The WCA also provides detailed information as to the amount of compensation an employee may receive. The amount of compensation depends upon whether medical testimony establishes that the employee is totally disabled or Apartially disabled. In addition to health care expenses, a totally disabled worker receives 66 2/3 percent of their normal average weekly wages. These payments may continue indefinitely. If a worker's injury does not permit normal work, but they are able to do "light duty" for the employer, that employee is "partially disabled". Benefits then equal the difference between what the employee is earning on "light duty" and the amount of their regular salary. The same is true if the employee's earning power is reduced due to the injury. Compensation is limited to 500 weeks.
Generally, a worker does not receive lost wage compensation for the first seven days after becoming disabled. However, all health care expenses are paid as discussed below. After seven days of being disabled, the employee begins to receive lost wage payments and if the disability exceeds fourteen days, payment is also made for the first seven days of disability. For a reoccurring injury, the seven-day waiting period does not have to be repeated.
The WCA also establishes a compensation schedule for the loss of body parts by amputation or for permanent loss of use. A body part (such as a finger, hand or leg) has a permanent loss of use when the injury cannot be corrected. Compensation is also available for disfigurements (such as burns or scarring) of the head, neck or face when the disfigurement is serious, permanent and unsightly. At the discretion of the WCA referee, up to 275 weeks wages as compensation may be awarded for disfigurement.
When injury causes death, WCA benefits are available to the spouse of the worker. Benefits stop when the spouse dies or remarries or begins to co-habitats with a member of the opposite sex. Benefits are also available to any child under the age of 18 when they are dependants of the deceased worker.
The WCA also provides that in addition to lost wage payments, all health care expenses must provided for by the employer. An employer must pay for reasonable surgical and medical services, hospital treatments, orthopedic appliances, prostheses, medicines and any other supplies necessary to treat an injured worker. Reasonable travel expenses are also included among this benefit. In most instances, the health care provider will bill the employer (or the employer's insurance company) directly.
The employer does have the right to force the employee to obtain treatment only from a list of designated physicians for the first thirty days of treatment. If the employee does not obtain treatment from the designated physicians, the right to payments for health care treatments may be waived. However, in the case of an immediate life threatening or urgent injury, this requirement may be waived. After the thirty-day period expires, the employee may obtain treatments from the physician or health care provider of their own choice as long as the employer is notified within five days of the first treatment.
When an employee and employer disagree over whether compensation is due for an injury, the matter may end up in litigation. Both the employee and the employer are entitled to legal representation. Generally, a worker who hires an attorney does so on a contingent fee basis. That is, if the attorney is successful in pursuing and obtaining WCA benefits for the employee a percentage of the recover is paid as a fee. That amount is usually twenty percent of all value received by the employee. Litigation expenses are often in addition to the contingent attorney fee and may or may not be advanced by the attorney and may or may not be the final responsibility of the worker regardless of the outcome of the litigation.