How Are Medical Benefits Paid Under the Pennsylvania Workers’ Compensation Act?

Many injured workers believe or are told that they must treat with a company doctor for the first 90 days after they are injured. In most cases, this is not true. For more information, just click here to read about the myth of the 90-day rule.

Generally speaking, an injured worker can go to the doctor of his or her choice for medical care, and, provided the care is for a part of the body your employer agrees was injured, the employer must pay for the medical care. The payments are calculated based on a fee schedule set up by the legislature in Harrisburg. If there is a billing dispute, or your employer or its insurance company believes that the care was not reasonable, the employer/insurer must request a utilization review of your doctor’s treatment through the workers’ compensation system. Regardless, an injured worker is not responsible or obligated to pay for any medical care related to a work injury.

Medical Coverage is Only for Your Work-Related Conditions

Be aware, however, that the Pennsylvania Workers’ Compensation Act only provides medical coverage for your work-related injuries or occupational disease, not for other medical conditions. For non-work related conditions, you must use your private insurance (such as Personal Choice or an HMO) or pay for the care out of your own pocket. The Workers’ Compensation Act does not protect or guarantee your right to receive medical care for injuries or conditions not related to your on-the-job injury. If you have the choice, always keep your private medical insurance.

If you have a question for Dan Siegel, just click here! All workers’ compensation matters are handled on a contingent fee basis, which means that you never pay a fee unless the Law Offices of Daniel J. Siegel, LLC gets you benefits or successfully prevents your employer from stopping your benefits. Give our office a call at (610) 446-3457, send an email, or fill out the form below.