Municipal employers across Pennsylvania frequently encounter employee workplace injury and illness claims that implicate both the Pennsylvania Workers’ Compensation Act (WCA) and the Pennsylvania Heart and Lung Act (HLA). While these statutes are often discussed together, they serve distinct purposes and impose different obligations on public employers. Understanding both the overlap and the distinctions is critical for level setting expectations, effective claims management, wage loss payments and reimbursements, budgeting, and labor relations.
Shared Purpose: Income Protection for Injured Employees
At their core, both the WCA and the HLA are designed to provide wage and medical benefits to employees who are injured in the course and scope of their employment. Each law ensures that qualifying employees receive compensation without needing to establish fault, offering a predictable and structured system for addressing workplace injuries.
In practice, claims involving police officers and firefighters may trigger eligibility under both statutes. As a result, employers must be prepared to coordinate benefit administration under each framework.
Key Differences in Coverage and Eligibility
The most significant distinction lies in who is covered:
- Workers’ Compensation Act: Applies broadly to nearly all employees in Pennsylvania, including municipal workers, regardless of job function.
- Heart and Lung Act: Applies narrowly to specific classes of public safety employees, most commonly police officers and firefighters, and only when they are temporarily incapacitated due to an injury incurred “in the performance of their duties.”
This narrower coverage under the HLA reflects its purpose: to ensure that public safety personnel, whose duties inherently carry higher risk, are not financially disadvantaged when injured when performing those inherently riskier job duties.
Benefit Structure: Partial vs. Full Wage Replacement
Another critical difference is the level of wage replacement:
- WCA Benefits: Typically provide partial wage replacement, generally about two-thirds of the employee’s average weekly wage, subject to statutory caps.
- HLA Benefits: Provide full salary continuation, meaning the employee receives their entire pre-injury wage during the period of temporary disability.
For municipal managers, this difference has budgetary implications. HLA benefits are employer-funded salary payments rather than insurance-based benefits, which can significantly increase short-term labor costs. However, remember your coverage through Delaware Valley Property & Liability Trust. This includes an Aggregate Limit of $100,000 that applies to all HLA claims within a given calendar year. You will be required to pay any HLA benefits due above that limit.
Medical Benefits and Treatment
Both statutes provide payment for reasonable and necessary medical treatment related to the work injury. However, these benefits are typically administered through the workers’ compensation system, even when an HLA claim is also in play.
Municipalities should ensure that:
- Employee Acknowledgement form is signed by their employees twice: upon hiring AND after a workplace injury occurs;
- Approved provider panels are properly posted in common areas for employee access;
- They do not direct medical care. Injured employees must select a medical provider from the approved provider panel list; and
- Medical management is coordinated to avoid duplication or administrative confusion.
- For DVPLT members: That no commitment to provide HLA benefits should be made before discussing with DVPLT. In most cases, HLA benefits will not be accepted or denied until the Workers' Compensation claim has been accepted. There will be cases where Workers' Compensation benefits will apply, but HLA benefits will be denied.
Duration and Termination of Benefits
The duration of benefits is another key distinction:
- WCA Benefits: May continue for extended periods, including long-term or permanent disability, depending on the nature of the injury and impairment.
- HLA Benefits: Are limited to the period of temporary incapacity. Once the employee is deemed able to return to work (even in a modified capacity, depending on case law and policy), HLA benefits cease. In addition, employers generally cannot terminate HLA benefits without a due process hearing. Thus, employers should work closely with their labor counsel before terminating HLA benefits.
How DVPLT and DVWCT Administer Claims if a Member is in Both Trusts
When an employee qualifies under both statutes, they may receive Heart and Lung benefits in lieu of workers’ compensation wage-loss benefits during the period of temporary disability. However, DVWCT administers workers’ compensation claims while DVPLT administers HLA claims as part of DVPLT coverage. Thus, there is a process that DVWCT and DVPLT must follow when administering both claims for members:
- Although eligible employees are entitled to their full salary under HLA, the workers’ compensation claim still exists and is important for medical coverage and potential recovery of costs.
- Because the threshold to receive HLA benefits is higher than the workers’ compensation benefits, DVPLT waits until DVWCT approves the workers' compensation claim before approving the HLA claim.
- DVPLT may still deny the HLA claim if the requirements are not met (for example, the employee is not a public safety employee, or the employee is not temporarily incapacitated due to an injury incurred in the performance of their duties).
- If both claims are approved, the workers’ compensation check is issued to the employee but mailed to the employer. The employee must then sign the check over to the employer to avoid “double dipping.”
- Employees can sign an Authorization for Alternate Delivery of Workers’ Compensation Benefits. Upon execution of this document, the workers’ compensation benefit checks can then become payable to the employer.
- HLA payments are then considered for reimbursement once the employer submits the HLA Salary Reimbursement form to DVPLT (this is included in the DVPLT HLA Playbook; let DVPLT know if you do not have a copy of this). A check will be issued directly to the employer once approved. This should be done on a quarterly basis or when the employee returns to work light or full duty.
This coordination is critical. Missteps can lead to overpayments, compliance risks, or disputes.
Administrative and Operational Considerations
For municipal managers, effective administration requires coordination across HR, finance, and legal functions. Best practices include:
- Early identification of eligible HLA claims to ensure proper classification and budgeting.
- Close coordination with your workers’ compensation carrier or TPA to track overlapping benefits and avoid duplication. If you are a DVPLT and DVWCT member, inform both Trust contacts immediately so that we can begin the claims administration process.
- Clear internal policies governing light-duty assignments and return-to-work expectations.
- Documentation and communication with employees to reduce misunderstandings and disputes.
Additionally, collective bargaining agreements may impact how these laws are implemented in practice, particularly regarding leave policies and supplemental benefits. Review your CBAs carefully to ensure your processes do not need to change to accommodate deviations from traditional practices.
Takeaways for Municipal Leadership
While the Workers’ Compensation Act and the Heart and Lung Act share a common goal of supporting injured employees, they operate differently in terms of eligibility, benefit levels, and duration. For municipal employers, the key is not just understanding each law in isolation but effectively managing their interaction.
By proactively aligning policies, coordinating benefit administration, and maintaining clear communication with stakeholders, municipalities can both support their workforce and manage financial and operational risk.
If you have any additional questions, please contact the Workers’ Compensation Claims Manager Linda Bengera at lbengera@dvtrusts.com or the Property and Liability Claims Manager Mark Harris at mharris@dvtrusts.com.
If you are interested in learning more about the Heart and Lung Act, register through our website for our Heart and Lung Act Virtual Training Session on October 6 from 12pm – 1 pm.