What are Wage Loss Benefits?
Wage loss benefits provide injured workers with a portion of the income they have lost due to their on-the-job injuries. While you might expect receiving wage loss benefits to be relatively simple, it can be deceptively complex. There are rules outlining wage loss eligibility, calculations to determine how much you can receive in benefits, and even distinctions based on what types of injuries you sustain. A Pennsylvania workers’ compensation attorney can help you navigate the wage loss process and receive the full compensation you are entitled to.
Statute of Limitations and Notice Requirements
You must notify your employer that you sustained a work-related injury within 120 days of the injury occurring (or, at times, within 120 of when you become or should have become aware that your injury is work-related). Failing to meet this deadline could result in a forfeiture of your wage loss and other workers’ compensation benefits. If you report your injury within 21 days of the accident that caused it, you may be eligible to receive compensation for lost wages since the date of injury.¹ If an injury is reported more than 21 days after the accident occurred, wage loss benefits will only apply starting from the date the injury was reported.
The Statute of Limitations for workers’ compensation cases is three years from the date you sustain your injury. There are very limited exceptions to this rule. The injury must still be reported to your employer within the first 120 days after the accident.
¹ How many days of work you missed due to your injury also factors into whether or not you can receive compensation back pay starting from the date of injury. You may not receive any wage loss benefits until you have missed more than 7 days. At that point, you receive lost wages for the 8th through 13th day unless you miss two weeks of work or more. Once you are out of work for 14 days, your benefits are retroactive to the first date of lost wages.
When does Wage Loss Coverage Begin?
Workers’ compensation coverage, including wage loss benefits, begins as soon as you start your job. Even if you were to be injured on your very first day on the job, you could still be eligible for wage loss benefits. In fact, injuries sustained during the first day or week are more common than you might think. Aside from the fact that injuries such as slips and falls can happen to anyone at any time, new workers may not be familiar with the equipment used at their new job, which can lead to injuries. It is for this reason that coverage starts on day one.
When do Benefits Begin?
Wage loss benefits begin only after you have missed seven days of work. However, that wording can be slightly misleading. Because workers’ compensation applies to so many different types of work, a “day of work” is any day of the week. If you work Monday through Friday, Saturday and Sunday still count towards your total number of days of work missed. For example, a worker who is injured on Monday and remains out of work may see their benefits begin on the Tuesday of the following week regardless of how many days they would have normally worked within that period.
Employees who miss 14 or more days of work may be eligible to receive back pay for the first seven days of missed work.² This results in three distinct brackets of wage loss eligibility based on how long workers have been unable to perform their jobs.
|Days of Work Missed||Wage Loss Eligibility|
|0-6||Does not qualify for wage loss benefits|
|7-13||Qualifies for wage loss benefits for each day after the seventh day|
|14+||Qualifies for wage loss benefits covering the entirety of your absence³|
² Back pay eligibility will also depend on whether or not your injury was reported to your employer within the first 21 days.
³ Temporary partial disability wage loss benefits have a maximum length of 500 weeks per claim. Total disability wage loss benefits do not have a limitation and are potentially lifetime.
Types of Wage Loss Benefits
There are several types of wage loss benefits, and which one applies to your case depends on the type of your injuries, the extent of your injuries, and how much they affect your ability to work. These wage loss benefit types include Temporary Total Disability (TTD), Temporary Partial Disability (TPD), specific loss benefits, and hearing loss benefits.
Total & Partial Disability Benefits
One primary difference between total and partial disability benefits is whether or not you are able to work with a partial wage loss. If your injuries put you out of work entirely while you recover, you are considered totally disabled. However, if you are still able to work with limitations, such as working fewer hours or in a different position that is not as strenuous, and you are losing wages, you are considered partially disabled. If you are earning the same wages as before your injury or more, you do not qualify for wage loss benefits.
Temporary disability benefits are capped at 500 weeks of compensation per claim. These 500 weeks do not have to be consecutive. For example, even after returning to work, you may need to undergo further surgeries connected to your initial injury which could put you out of work again.
Your designation may shift from totally disabled to partially disabled as your injuries heal and you are able to begin working again.
Shift from Total to Partial Disability Benefits Based on IRE
An Impairment Rating Evaluation (IRE) can be requested by your employer or their insurer after you have been collecting total disability benefits for 104 weeks. If you have reached Maximum Medical Improvement (MMI) and the impairment rating finds you less than 35% impaired, your benefits can be changed from total to partial disability in status. The amount of your payment does not change based on an IRE, only the duration of your entitlement.
Calculating Wage Loss Benefits
Calculating your wage loss benefits can be a bit tricky due to all of the variables that are involved. The three primary components are your pre-injury Average Weekly Wage (AWW), your post-injury gross wages, and Pennsylvania’s statewide AWW.
Pre-Injury AWW – Your average weekly wage is generally calculated by averaging the highest three quarters (13-week periods) of earnings during the year leading up to your injury. There are alternative methods depending on the circumstances of each case.
Post-Injury Gross Wages – The amount you are making in your post-injury position if partially disabled.
Statewide AWW – The average weekly wage of Pennsylvania workers from the previous year, with which the maximum compensation rate is calculated.
When calculating both your pre-injury AWW and post-injury gross income, you should use income from all jobs you have. If you worked two jobs before your injury, then your pre-injury AWW should be the combination of your wages from both of them. If you are totally disabled and unable to work either of your jobs, your benefits should be based on the total wages lost, not just the wages lost from the job at which you were injured. The same applies if you are partially disabled and unable to work one or either job at full capacity. However, earning from self-employment might not be included in the pre-injury AWW, but could be counted as post-injury wages. This can get very complicated.
Total Disability Benefit Rate Calculation
For total disability, how your compensation is calculated differs based on how your AWW compares to the statewide AWW. There are four wage brackets you can fall into.
1. Benefits are set at the maximum compensation rate, calculated from the statewide AWW.
2. Benefits are set at ⅔ of your pre-injury AWW.
3. Benefits are set at a flat compensation rate, based on the lower bound of the second bracket.
4. Benefits are set at 90% of your pre-injury AWW.
The AWW thresholds associated with each bracket and the maximum compensation rate are re-adjusted each year. You will need to use the compensation rates from the year in which your injury occurred.
Check out this article to learn more about how to calculate your 2021 compensation rate from your Average Weekly Wage.
Partial Disability Calculation
Partial disability benefit calculations are calculated by subtracting your post-injury gross weekly wages from your pre-injury AWW and multiplying the result by ⅔. For example, let’s say you made $900 per week before your injury and are now making $600 per week. The difference is $300, which when multiplied by ⅔ gives you your compensation amount of $200 per week.
Keep in mind that partial disability benefits are still capped by the statewide maximum compensation rate for the year in which your injury occurred.
Schedule a Consultation
Have you lost wages due to a work injury that left you partially or totally disabled? While wage loss benefits may not replace 100% of your lost income, they can help you make ends meet while you recover or can provide for you if you will be unable to return to work.
My name is Geoffrey Hillsberg, and I have been solely practicing Workers’ Compensation law in the State of Pennsylvania since 1995. If you have been injured on the job, please contact my law office today. I will fight for your right to compensation after a workplace injury.
The advice offered above is general in nature and may not be applicable to every case. Consultation with an attorney is highly recommended. Reliance on this advice does not represent the formation of an attorney-client relationship in the absence of a fee agreement with Mr. Hillsberg.