Workers’ Compensation Specific Loss Benefits

Workers’ compensation is a vital safety net for employees who suffer work-related injuries or illnesses. In Pennsylvania, this system ensures that injured workers receive financial support and medical care without needing to prove fault.

Among the various types of workers comp benefits, there is a special type of insurance called “specific loss benefits.” These benefits address severe, permanent injuries.

Understanding Specific Loss Benefits in Pennsylvania Workers’ Compensation

Specific loss benefits are a category of workers’ compensation benefits designed to compensate for permanent injuries that result in the loss of a body part or the loss of use of a body part, including those due to injury, occupational disease, repetitive stress, amputation, or permanent disfigurement.

Unlike general disability benefits, which compensate for lost wages, specific loss benefits are paid through your employer’s workers’ compensation insurance regardless of whether the worker can continue working. These benefits recognize the significant impact such injuries have on a worker’s life and livelihood.

What Are the Types of Injuries Covered For Specific Loss Benefits?

Specific loss benefits cover a range of serious injuries, including:

• Amputation: Loss of limbs, fingers, toes, or other body parts.
• Disfigurement: Severe scarring or disfigurement, particularly of the face, head, or neck.
• Hearing Loss: Permanent hearing impairment due to workplace conditions.
• Vision Loss: Permanent loss of vision in one or both eyes.
• Loss of Function: Permanent loss of use of a body part, even if the part is not amputated.

What Are the Eligibility Criteria for Specific Loss Benefits?

To qualify for specific loss benefits in Pennsylvania, an injured worker must meet the following criteria:

• Work-Related Injury: The injury must have occurred due to employment activities.
• Permanent Injury: The injury must result in a permanent loss or loss of use of a body part.
• Medical Documentation: A medical professional must confirm and document the injury.

The Application Process for Specific Loss Benefits

Applying for specific loss benefits involves several steps:

• Report the Injury: Notify your employer of the injury immediately.
• Seek Medical Treatment: Get medical attention and obtain documentation of your injury and its permanency.
• File a Claim: Submit a formal workers’ compensation claim with the Pennsylvania Bureau of Workers’ Compensation.
• Consult an Attorney: It’s advisable to seek legal assistance to ensure your claim is accurately completed and submitted.
• Await Decision: The insurance company will review your claim and decide.

How Are Specific Loss Benefits Calculated?

The amount of specific loss benefits is calculated based on the severity and type of injury. Pennsylvania law assigns a specific number of weeks of compensation for different injuries. For example:

• Loss of a Hand: 335 weeks of compensation.
• Loss of a Foot: 250 weeks of compensation.
• Loss of an Eye: 275 weeks of compensation.

The benefit amount is typically two-thirds of the worker’s average weekly wage, subject to minimum and maximum limits set by state law.

What Are the Duration and Limits of Specific Loss Benefits?

The type of injury predetermines the duration of specific loss benefits. These benefits are paid for the weeks assigned to each type of injury, regardless of the worker’s ability to return to work. Additionally, workers are entitled to benefit from medical expenses related to the injury for as long as treatment is necessary.

Appeal Process for Denied Claims

If your claim for specific loss benefits is denied, you have the right to appeal the decision:

• File an Appeal: Submit an appeal to the Pennsylvania Workers’ Compensation Appeal Board.
• Request a Hearing: A hearing will be scheduled where you can present evidence and arguments.
• Gather Evidence: Collect additional evidence to support your claim, such as medical records and expert testimony.
• Legal Representation: Having an attorney represent you during the appeal process is highly recommended.
• Board Decision: The Appeal Board will review the case and decide.

Munley Law Workers’ Compensation Attorneys Can Help

Specific loss benefits provide important financial support to workers who suffer permanent, severe injuries.

Understanding the types of injuries covered, the eligibility criteria, and the application process can help you secure the benefits you deserve. An experienced Pennsylvania workers’ compensation attorney at Munley Law can help if you have suffered a permanent workplace injury or illness. We will fight until you receive the compensation you need.

Call Munley Law today or message us using the form on this page to talk to an attorney about your claim.