If you employ just one worker in Pennsylvania—full-time, part-time, or seasonal—you likely need to carry Pennsylvania workers comp insurance. Under the Workers compensation Pennsylvania requirements, coverage is mandatory in nearly every industry. Failing to comply could lead to felony charges and substantial penalties.
This comprehensive guide covers who needs coverage, what it includes, how the Pennsylvania workers comp claim process works, and what recent legal changes mean for your business.
WHO NEEDS COVERAGE UNDER STATE LAW
The Pennsylvania Workers’ Compensation Act requires nearly all employers to carry insurance. If your business has at least one employee who could be injured on the job, you’re required to be insured.
Coverage applies to:
- Full-time and part-time employees (from day one)
- Seasonal staff and temporary workers
- Agricultural employees earning $1,200+ per year and working over 30 hours per week
- Domestic workers logging more than 40 hours per week for one employer
Exemptions include:
- Sole proprietors and LLC members with no employees (coverage optional)
- Certain executive officers who file for exclusion
- Casual labor not tied to core business operations
- Federal employees and longshoremen (covered by federal laws)
- Real estate salespersons under specific arrangements
This law protects both employees and employers—offering quick access to care while shielding employers from personal injury lawsuits.
PENNSYLVANIA WORKERS COMPENSATION BENEFITS
The foundation of Pennsylvania’s system is no-fault benefits—employees receive care regardless of who caused the injury.
Standard Pennsylvania workplace injury benefits include:
Medical Care: Full treatment coverage with no deductible or co-pay when using an approved provider for the first 90 days
Wage Loss Benefits: Up to $1,347 per week for Temporary Total Disability (TTD) as of January 2025, generally two-thirds of weekly earnings
Specific Loss Awards: Set payments for permanent damage like lost fingers, limbs, or eyesight
Death Benefits: Burial coverage and ongoing income for surviving dependents based on their level of support
Pennsylvania also supports return-to-work programs and offers a public option through the State Workers’ Insurance Fund (SWIF), which competes with private carriers. Rates are set by the Pennsylvania Compensation Rating Bureau (PCRB) and reflect job type, safety history, and prior claims.
Want a simple breakdown of how workers’ comp works? Read our guide: Workers’ Comp Insurance Basics – What You Should Know.
COMMON INJURIES & INDUSTRY-SPECIFIC RISKS
Each year, thousands of Pennsylvania workplace injury benefits are paid out for a range of injuries. Sprains, strains, back injuries, and winter slip-and-fall accidents top the list.
Most common injury causes:
- Overexertion: Lifting heavy boxes or patients leads to muscle and spinal injuries
- Falling Objects: Construction sites often report head trauma from dropped tools
- Slips and Falls: Snow and ice cause spinal and joint injuries, especially in January when average lows dip to 12°F
Real example: A warehouse worker in Philadelphia fractured multiple vertebrae after slipping on an icy ramp. The policy covered six months of wages and medical bills under the Pennsylvania workers comp claim process.
COST FACTORS & RATE EXAMPLES
Your premium depends on your industry risk level, payroll, and past claim history. Rates are calculated per $100 of payroll, with higher-risk jobs paying more.
Premium rates vary significantly by industry classification and risk level. Construction trades typically face higher rates due to injury risk, while office-based work generally has lower rates. Exact rates depend on specific class codes, claims history, and insurer underwriting.
Your final cost is adjusted based on your experience modification rate (EMR), which reflects past claims. A strong safety program can lower your EMR and premium over time.
Pennsylvania Workers Comp Claim Process: Critical Deadlines & Procedures
Under Pennsylvania Workers’ Compensation Act requirements, strict deadlines are established when injuries occur. Employers must act quickly to meet legal requirements for reporting and claim processing.
Claim steps with legal deadlines:
Employee Notification: The employee has up to 120 days to notify their employer of an injury.
Employer Reporting: The employer must file a “First Report of Injury” (FROI) with the Bureau of Workers’ Compensation within 7 days after the date disability begins for injuries causing more than one day/shift of lost time.
Medical Treatment: Employee must use an approved provider for 90 days from first treatment date (only if employer has properly posted a 6-provider panel and obtained written acknowledgment).
Wage Benefits Begin: After 7 calendar days of disability, benefits are payable on the 8th day. If disability exceeds 14 days, benefits are paid retroactively for the initial seven days.
Disputes: May be appealed before a workers’ comp judge if a claim is denied.
Failure to follow this process and meet these critical deadlines could result in penalties or delayed benefits. Proper documentation and timely reporting are fundamental to maintaining compliance under Workers compensation Pennsylvania requirements.
Pennsylvania Workers Comp Penalties
Violating Pennsylvania workers comp penalties laws can lead to serious consequences:
- Fines up to $15,000 and potential felony charges for willful non-compliance
- Civil lawsuits: If uninsured, the business may have to pay full medical and wage costs out-of-pocket
- Stop-work orders: The state can shut down operations until coverage is restored
Enforcement has increased across industries, especially construction, healthcare, and transportation. These penalties underscore the importance of maintaining continuous coverage and proper compliance procedures.
RECENT UPDATES FOR 2025 EMPLOYERS
Wage cap increase: Maximum weekly wage benefits rose to $1,347/week in 2025
SWIF competitiveness: The public fund continues to offer affordable options for small businesses
Claim deadlines: Strict enforcement of reporting deadlines continues—employers must act quickly or risk penalties
COMPLIANCE REQUIREMENTS
Pennsylvania employers must maintain workers’ compensation coverage and follow proper claim reporting procedures to meet state requirements. Understanding the specific deadlines, benefit structures, and penalty frameworks outlined in this guide provides the foundation for effective risk management and legal compliance.
For coverage estimates, use our premium calculator or contact licensed advisors at (855) 718-7552 for guidance on Pennsylvania workers’ compensation requirements.
