Claims and Indemnity

The maximum temporary total disability in 2015 is $951, based on 66 2/3 of the average weekly wage. The state's average weekly wage is $1,426.50. Permanent total and partial disability is paid up to the same maximum. PPD is determined by the type of injury, age of the claimant, and other factors.
 
Claims are adjusted in-house by field investigators.
 
For more information regarding workers’ compensation claims and benefits available, visit the Bureau of Workers' Compensation.

Medical Benefits

All medical charges for treatment and equipment causally related to the injury are covered. A treating physician is chosen from a Panel of Physicians posted by the employer. Assuming the posting requirements are satisfied, the injured employee must treat with a panel physician for a period of 90 days following the initial visit. After that, the employee is usually free to treat with a physician of his/her choice.
 
Recent legislation established a medical fee schedule for workers' compensation treatment in Pennsylvania. This fee schedule reimburses health care providers at 113% of the prevailing Medicare rate.
 
SWIF has registered nurses on staff assigned to assist staff Medical Reviewers. Typically, they help evaluate the causal relationship of the injury to a questioned treatment or charge.

Rehabilitation

Vocational rehabilitation is an optional program offered by SWIF that includes training and job placement. The worker can choose not to participate. To modify a claimant’s benefits the insurer must convince a workers' compensation judge that there is a job available within the injured worker's restrictions. While the petition is pending, the injured worker will continue to receive benefits.

Resources

  • When Coverage Begins - Employer
  • When Coverage Begins - Employee
  • What Does Workers’ Compensation Insurance Cover

Contact Information

State Workers' Insurance Fund
100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA 18505-5100 
 
Phone: (570) 963-4621
Fax: (570) 963-3402
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