Back Surgery After a Work Injury in Pennsylvania: What Workers' Compensation Covers

Attorney Answer

If the injury happened at work, workers' compensation should pay for the surgery and your recovery, and pay two-thirds of your wages, up to a statewide maximum, while you cannot work. What matters now is whether your employer was told about the injury and whether its insurer has accepted the claim. If either is uncertain, the deadlines at the end of this page are what protect it.

Your medical care. Under Section 306(f.1)(1)(i) of the Workers' Compensation Act, the employer pays for reasonable surgical and medical services, medicines and supplies, as and when needed, including an additional opinion when invasive surgery may be necessary. If the employer has posted a list of at least six designated providers, you treat with them for 90 days from your first visit. Under Section 306(f.1)(7), a provider may not hold you liable for care related to a compensable injury, or bill you for the difference between its charge and what it is paid.

Your wages while you recover. Under Section 306(a)(1) of the Workers' Compensation Act, total disability pays two-thirds of your wages, up to a statewide maximum, for as long as the total disability lasts. Under Section 306(e), the first seven days are paid only if the disability lasts fourteen days or more. If you go back to work at lower pay, Section 306(b)(1) pays two-thirds of the difference between your wages before the injury and what you can earn afterward, for not more than 500 weeks.

Has the claim been accepted? Under Section 406.1(a) of the Workers' Compensation Act, the employer and its insurer must promptly investigate, and the first payment is due no later than the 21st day after they learn of the disability. If the insurer contests the claim, Section 406.1(c) requires it to tell you promptly, on the department's form, and to state the grounds. If it pays on a temporary basis while it investigates, Section 406.1(d)(2) requires it to tell you that the payments are not an admission of liability; the department then sends you a notice explaining that temporary payments last at most 90 days and that you may need to file a claim petition in time. The document's title tells you which of these you have.

Exams and going back to work. Under Section 314(a) of the Workers' Compensation Act, you must attend a reasonable examination by a provider your employer selects and pays for, if asked; a workers' compensation judge can order it, and refusing a judge's order suspends compensation while the refusal lasts. Under Section 306(b)(2), if your employer has a specific job open that you are capable of performing, it must offer it to you. After 104 weeks of total disability, Section 306(a.3) allows the insurer to request an examination to rate your impairment, which can change the kind of benefits you receive.

What you can do

1. Make sure your employer has written notice of the injury, with the date and how it happened, and keep a copy.

2. Find every document you have received from the employer's insurer, and look at its title: whether it accepts the claim, pays it temporarily, or denies it.

3. Keep your surgeon's records and any work restrictions, and give the restrictions to your employer in writing.

4. Before you sign anything that ends or changes your benefits, talk to a Pennsylvania workers' compensation lawyer.

5. Even if you are handling this yourself, you would be best served by a brief phone consultation with a local Pennsylvania attorney before you act. Most lawyers offer a short initial call at no cost, and a few minutes on your specific facts — and on how your court actually handles this — is worth more than any general guidance, including this page.

⏱ Time limits apply. Notice to your employer within 21 days protects benefits from the start, and no compensation is owed without notice within 120 days unless the employer already knew (Section 311 of the Workers' Compensation Act). A claim is barred unless, within three years of the injury, the parties agree on compensation or a petition is filed (Section 315 of the Workers' Compensation Act).