Master Appeals In PA Workers’ Compensation
The Workers’ Comp Appeal Board
The Workers’ Compensation Appeal Board (WCAB) serves as an independent appellate body. It reviews decisions made by Workers’ Compensation Judges (WCJs). Injured workers can turn to the WCAB if they identify legal or procedural flaws in a judge’s decision.
The WCAB’s Structure
The WCAB structures its operations with 3 to 15 members appointed by the Governor of Pennsylvania. These members form panels or work as a full board to review workers’ compensation claim appeals. A quorum of members votes on decisions, ensuring a fair and consistent process.
Ethical Standards
The WCAB operates under a strict code of ethics outlined in Act 147 of 2006. These guidelines ensure impartiality and prohibit conflicts of interest or ex parte communications.
How Do Appeals To The Workers’ Compensation Appeals Board Work?
In Pennsylvania workers’ compensation cases, injured workers can appeal only final decisions that WCJs issue. A final decision resolves all claims and issues between the injured worker and the employer/insurance company. A workers’ compensation lawyer can help clarify whether or not to file an appeal.
Common Grounds For Appeal
Non-Compliance with the Workers’ Compensation Act: The decision conflicts with Pennsylvania workers’ comp laws.
Errors of Law: A Workers’ Compensation Judge misapplied or misunderstood the law.
Lack of Substantial Evidence: The judge did not support their decision with sufficient or credible evidence.
Improper Conduct or Fraud: Unethical behavior by a party or the insurance company influenced the outcome.
Failure to Issue a Written Decision: WCJs must provide clear, reasoned decisions, explaining the basis of their rulings.
Deadlines For Filing An Appeal
20-Day Deadline: Injured workers must file an appeal with the Pennsylvania WCAB within 20 days after the judge mails the decision.
14-Day Cross-Appeal Deadline: If another party files an appeal, you have 14 days to file a cross-appeal.
What Happens After Filing an Appeal?
Once submitted, the WCAB:
Acknowledges Receipt: The Board establishes a briefing schedule and confirms its review of the case.
Accepts Briefs and Oral Arguments: Both parties may submit briefs and participate in oral arguments. The Board does not hold evidentiary hearings. It instead reviews the case based on the WCJ’s record.
Issues a Written Decision: After reviewing the appeal, the WCAB will issue a written decision. This decision may affirm, modify, or reverse the WCJ’s ruling.
Nunc Pro Tunc Appeal
A nunc pro tunc appeal allows injured workers to file an appeal after the 20-day deadline in exceptional circumstances. These appeals are granted sparingly and require proof of non-negligent delay, such as:
Medical Emergencies: Hospitalization of the injured worker or their attorney.
Administrative Errors: Improper service of the judge’s decision.
Can The WCAB Remand A Case To The WCJ?
Yes, the WCAB has broad discretion to remand cases for additional proceedings. Common reasons include:
Inadequate Findings: If the WCJ failed to make necessary factual findings.
Legal Misapplication: When the WCJ incorrectly applied PA workers’ compensation laws.
New Evidence: When critical evidence emerges that could affect the outcome of the case.
A remand does not completely redo the case. Instead, it focuses on specific issues identified by the WCAB. Injured workers should consult with a workers’ compensation lawyer to prepare for remand proceedings.
Common Types of WCAB Petitions
The Workers’ Compensation Appeals Board has original jurisdiction over certain petitions. These include:
Specific Loss Claims: Petitions seeking compensation for multiple injuries resulting in permanent impairment.
Further Medical Expenses: Requests for reimbursement under older provisions of the Workers’ Compensation Act.
Guardian Appointments: For minors or incapacitated individuals entitled to workers’ comp benefits.
Commutations: Requests to convert ongoing benefits into a lump-sum payment.
Conclusion
The Pennsylvania workers’ compensation appeal process offers injured workers an opportunity to challenge unfavorable decisions. A workers’ comp lawyer can help you determine if you have grounds for an appeal.
Don’t handle your workers’ compensation claim alone. If you feel you may have an appealable issue, reach out for a free consultation. Let us help you get the benefits you deserve. Give us a call 24/7 at (215) 609-4183.
