You Got Hurt
on the Job.
You Paid Into This.

Specific Loss Benefits

What it covers: Pennsylvania law provides a fixed schedule of benefits for the permanent loss of — or loss of use of — specific body parts: fingers, hand, arm, toe, foot, leg, or an eye. Serious facial disfigurement and hearing loss are also covered under specific loss provisions. These benefits are paid for a set number of weeks defined in the Workers' Compensation Act, regardless of whether you can work.

How it's calculated: The Act lists the number of weeks of compensation owed for each body part or sense lost. For example, the total loss of an arm provides significantly more weeks of benefits than the loss of a finger. The weekly amount is your two-thirds AWW rate. Partial loss of use is paid as a percentage of the total loss scheduled weeks.

Where insurers underpay: Insurers frequently dispute the percentage of loss — arguing, for instance, that a hand is 60% impaired rather than 75%. That percentage difference directly reduces what you're paid. We work with independent medical evaluators who assess functional loss honestly, not in the insurer's favor.

Medical Treatment Benefits

What it covers: Pennsylvania employers and their insurers must pay for all reasonable and necessary medical treatment related to your work injury. This includes emergency care, hospitalization, surgery, physical therapy, prescription medications, specialist referrals, psychological treatment when warranted, and durable medical equipment.

How it's calculated: There's no dollar cap on medical benefits in Pennsylvania comp. Treatment must be reasonable, necessary, and causally related to the work injury. The insurer pays the provider directly at the fee schedule rate set by the Bureau of Workers' Compensation.

Where insurers underpay: Utilization Review (UR) is the insurer's primary weapon here. They can request a UR of any treatment — and if a reviewer determines care is not reasonable and necessary, they can deny payment. The UR process has strict deadlines and a specific appeals path. Many workers lose benefits simply because they don't know how to respond. We handle UR challenges and appeals from the beginning.

Mileage & Travel Benefits

What it covers: If you travel to medical appointments related to your work injury, you're entitled to reimbursement for mileage, parking, and in some cases public transportation costs. This includes travel to the doctor, physical therapy, specialist appointments, and the pharmacy to fill comp-related prescriptions.

How it's calculated: Mileage is reimbursed at the rate set by the Bureau of Workers' Compensation, which adjusts periodically. You must keep records of your trips — date, destination, round-trip mileage — and submit a reimbursement request to the insurer.

Where insurers underpay: This is a benefit most injured workers don't know exists, and insurers do nothing to inform them. Over the course of a serious injury requiring months of treatment, unreimbursed mileage can add up to hundreds of dollars. If your insurer has never mentioned this benefit, ask. If they refuse to pay it, we can compel it.

Impairment Rating Evaluation (IRE) — The Benefit That Quietly Caps Your Claim

What it is: After you've received 104 weeks of total disability benefits, your employer or their insurer has the right to request an Impairment Rating Evaluation. A doctor — designated by the Bureau of Workers' Compensation from a list maintained by the Bureau — examines you and assigns you a whole-body impairment rating using AMA guidelines. If that rating comes back below 35%, your status is automatically changed from total to partial disability, which carries a 500-week cap on future wage loss benefits.

Why this matters so much: Most workers don't understand what's happening at the IRE. They show up for what feels like a routine medical exam — it's not. The examining physician is applying a specific methodology (currently the AMA Guides 6th Edition in Pennsylvania) that tends to produce lower ratings than your own treating physician might assign. A rating of 34% versus 36% means the difference between capped partial benefits and continued total disability with no cap.

What you can do: You are entitled to have an attorney present at the IRE. If the assigned impairment is below 35%, you have the right to challenge it — by requesting your own independent IRE or by litigating the methodology used. Pennsylvania courts have found IRE challenges successful when the examining physician failed to properly apply the required guidelines. This is one of the most important moments in a long-term claim, and it's where we focus hard.

Where insurers use this against workers: Some insurers schedule the IRE at the first possible moment after 104 weeks and select physicians whose methodology consistently produces low impairment ratings. The scheduling notice itself contains legal rights that are easy to miss. If you've received an IRE notice or already had the evaluation, contact us before accepting any change in your benefit status.

Commutation & Lump-Sum Settlement

What it covers: Pennsylvania workers have two main ways to resolve a comp claim as a lump sum. A commutation converts future weeks of scheduled benefits (such as specific loss benefits) into a present-value lump sum. A Compromise and Release (C&R) agreement settles all future benefits — wage loss and medical — for a one-time payment, closing the claim.

How it's calculated: A commutation is calculated using an actuarial present-value formula approved by the Bureau. A C&R settlement is negotiated, and the amount reflects the litigation risk, the expected duration of benefits, and the value of future medical treatment. Every C&R agreement must be reviewed and approved by a Workers' Compensation Judge before it takes effect.

Where insurers underpay: Lump-sum offers from insurers are almost always low — sometimes dramatically so. They benefit from settling because they eliminate long-term exposure. An injured worker may be offered a number that sounds large but represents a fraction of the lifetime medical and wage loss benefits they'd be entitled to. We calculate what the full value of a claim looks like and negotiate from that number, not theirs.

Death Benefits for Surviving Family

What it covers: When a work injury or occupational disease causes a worker's death, Pennsylvania's Workers' Compensation Act provides benefits to the surviving spouse and dependent children. A surviving spouse receives a percentage of the deceased worker's average weekly wage for life or until remarriage. Dependent children receive additional benefits up to defined ages. Reasonable burial expenses are also covered.

How it's calculated: The death benefit for a surviving spouse is 51% of the deceased worker's AWW, subject to the statewide maximum and minimum. Children's additional benefit percentages are set by statute. The Bureau of Workers' Compensation must approve the allocation. Dependency is determined by actual financial reliance, not just legal status.

Where insurers underpay: Insurers dispute the causal connection between the work injury and the death — particularly in occupational disease cases where the latency period is long, or in cases where the worker had other health conditions. They also challenge dependency status for adult children in school or family members who weren't claimed as tax dependents. We work with medical and economic experts to establish causation and calculate what the family is owed.