Written by Attorney Michael O’Donnell

Generally speaking, the Pennsylvania Workers’ Compensation Act provides for three (3) forms of benefits to injured workers:

1. Wage loss benefits when an injury interrupts a worker’s ability to earn a wage;
2. Medical benefits covering 100% of the reasonable medical expenses necessary to treat a work injury; and
3. Specific loss benefits, which are cash benefits to the injured worker when they suffer the loss of use of a body part (often by way of dysfunction or amputation) or scars to certain areas of their body caused by an on-the-job injury.

Understanding How Specific Loss Benefits Work

The law is set up in such a way that an injured worker cannot collect both total disability wage loss payments and payments for a specific loss simultaneously. The law provides that specific loss benefits are paid after an injured worker stops receiving weekly total disability wage loss payments.

Because of these legally imposed limitations, it is common for an injured worker who has suffered an amputation, permanent scar, or loss of use of a body part to pursue an award of specific loss benefits from a Workers’ Compensation Judge and not begin receiving those payments until they stop receiving their weekly total disability payments.

Workplace injuries involving both total disability and specific loss are frequently some of the most serious and severe injuries we see in this area of the law. I have personally observed situations where these injuries are so devastating that they have, tragically, led to loss of life. When that occurs, the injured worker’s surviving dependents are generally eligible to receive fatal claim benefits and coverage for a set amount of funeral expenses.

What Happens to Specific Loss Benefits After Death?

But what happens when an injured worker suffers a total disability, a specific loss due to amputation, loss of use, or disfigurement, and then passes away before their specific loss benefits are finally decided by the Court and before those payments are made? Does the insurance company just get to keep the specific loss money? Keep in mind, the law provides that specific loss payments do not become payable under the law until after the injured worker’s total disability wage loss checks stop. Like most issues in the law, the answer to the earlier question is: it depends.

Case Example: Recovering Benefits for a Deceased Worker

I had represented a gentleman who suffered a severe work-related injury to his leg. He appropriately received total disability benefits for that injury. Despite best efforts from his medical team, the injury eventually required amputation of his leg below the knee. 

With that, he became eligible for specific loss benefits, which were awarded by a Judge. Because my client was receiving total disability payments, the law provided that his specific loss payments would not yet begin. Not long thereafter, my client succumbed to a non-work-related medical ailment and he passed away. He was still receiving total disability wage loss benefits for his work injury when he passed. He never received a penny of the specific loss benefits awarded by the Court.

This brings us back to the question raised earlier: Does the insurance company just keep the specific loss money that had been awarded by the Court? Not this time. After my client’s passing, we took the issue back to the Court with his surviving spouse substituted in his place as the “Claimant.” The law was on our side, but not necessarily for the reasons most would believe.

Section 306(g): Payment of Specific Loss Benefits to Survivors

Section 306(g) of the Workers’ Compensation Act provides that specific loss benefits are payable to the surviving spouse or dependents of the injured worker if they have not yet been paid to the injured worker prior to his death and the injured worker’s death was due to causes unrelated to his work injury. The key factors in our case were that the specific loss benefits had actually been awarded by a judge prior to my client’s passing and his death was due to a medical ailment unrelated to his work injury. Securing the award of specific loss benefits during the injured worker’s lifetime was an important fact to our success in recovering payment of the benefits to his surviving spouse. Additionally, under then-existing precedent, proving that his passing was due to medical ailments unrelated to his work injury provided for a favorable result under Section 306(g).