Step 1: Report the Injury to Your Employer Immediately
Pennsylvania law sets three critical reporting windows:
- Within 21 days — benefits are retroactive to the date of injury
- Between 21 and 120 days — you can still report, but benefits start from the date you reported, not the injury date
- After 120 days — the claim may be barred entirely
Report in writing whenever possible. For injuries that develop gradually (carpal tunnel, repetitive stress, occupational diseases), the clock starts from the date you knew or should have known the condition was work-related.
Step 2: Get Medical Treatment and Document It Correctly
Every treating provider must record in the medical chart that your injury is work-related. Insurance companies look for any medical record that does not explicitly connect the condition to work and use those records to argue the injury is unrelated to employment.
Pennsylvania’s panel provider rule requires you to treat with a designated provider on your employer’s panel list for the first 90 days — if your employer met all four requirements to post a valid panel. After 90 days, you may choose your own physician. See our guide on seeing your own doctor for a workers’ comp claim.
Step 3: The Insurance Company Accepts, Modifies, or Denies
Within 21 days of notice, the insurance company must take one of three actions:
- Notice of Compensation Payable (NCP) — accepting the claim, benefits begin
- Notice of Temporary Compensation Payable (TNCP) — paying temporarily for up to 90 days while investigating
- Notice of Denial — triggering your right to file a Claim Petition
If the insurer pays under a TNCP for 90 days without converting to a full NCP, the claim is deemed accepted. If they deny, your case goes before a Workers’ Compensation Judge.
Step 4: Understand What Benefits You Are Entitled To
Pennsylvania workers’ compensation covers four main categories:
- Wage loss benefits — weekly payments at roughly two-thirds of your AWW, up to the 2026 maximum of $1,394/week
- Medical benefits — all reasonable and necessary treatment with no co-pays or deductibles
- Specific loss benefits — fixed payments for permanent loss of specific body parts
- Disfigurement benefits — up to 275 weeks for serious permanent disfigurement of the head, face, or neck
Step 5: How Weekly Benefits Are Paid
Once benefits are accepted, the insurance carrier pays weekly — typically by check or direct deposit, beginning within 10 days of the employer’s notice of injury. Benefits cover both total and partial disability:
- Total disability — your full weekly compensation rate when you cannot work at all
- Partial disability — two-thirds of the difference between your pre-injury AWW and current earnings, for up to 500 weeks
Step 6: The 104-Week Milestone
After 104 weeks of total disability, the insurance company can request an Impairment Rating Evaluation. If the rating comes back below 35 percent, benefits automatically convert from total to partial disability, capped at 500 additional weeks. If the rating is 35 percent or above, total disability continues. The IRE is one of the insurance company’s most powerful tools — contesting an unfavorable one requires prompt legal action.
Can the Insurance Company Stop My Benefits Without Warning?
No. The insurance company cannot unilaterally stop, reduce, or suspend your benefits without either your agreement or a successful petition before a Workers’ Compensation Judge. If they stop paying without a court order, that is a violation of the Act and you have legal remedies including penalties and interest.
Workers’ comp benefits are not subject to federal or Pennsylvania state income tax. You receive your full benefit amount without any tax withholding.