What Is the Adjudication Process for Workers’ Compensation in Pennsylvania?

Suffering an on-the-job injury or job-related illness and being left unable to work – even temporarily – can be scary and stressful. Not only are you concerned for your health and perhaps wondering how you will cover your medical expenses and your usual bills, but now you have to deal with a workers’ compensation claim. A workers’ compensation claim, much like a job-related injury or illness, can be complex – especially if your employer disputes the claim.

Adjudication, the process of litigating a workers’ compensation case through the Pennsylvania court system, can be lengthy and complicated. Having an experienced Hanover workers’ compensation lawyer to walk you through the process and fight on your behalf can make all the difference in the outcome of your claim – and your stress level during your case.

How does PA workers’ compensation work?
Pennsylvania workers’ compensation law is designed to protect both employees and employers by covering medical treatment and “compensating employees for lost wages associated with work-related injuries and disease. Employers provide for the cost of such coverage while being protected from direct lawsuits by employees.” Most employers are required to carry workers’ compensation insurance, and those who fail to do so who are not considered exempt under state law “may be subject to lawsuits from employees and criminal prosecution by the commonwealth.” In other words: Pennsylvania does not take workers’ compensation coverage and claims lightly.

According to the Pennsylvania Department of Labor and Industry, “disputed workers’ compensation cases are handled by workers’ compensation judges (WCJs) within the Workers’ Compensation Office of Adjudication.” The process includes multiple steps and critical deadlines at various stages:

• Step 1: Filing a claim. In order for your case to reach a WCJ, either you or your attorney must file a Claim Petition with the workers’ Compensation Office of Adjudication.
• Step 2: Notifying all parties involved. Under PA law, “the party filing the petition must send a copy to all other parties.” Once this step is complete, you will receive a “Notice of Assignment” from the Workers’ Compensation Office of Adjudication stating that a petition has been assigned and providing the name of the judge who will hear your case. The workers’ compensation judge will be one who hears cases in or near the county in which you reside. Soon after the petition assignment is distributed to all parties, a hearing will be scheduled.
• Step 3: Responding party files an answer. Per the PA Department of Labor, “it may be essential that the responding party file an answer within a specific time limit.” Any information about regarding filing an answer – including details about time limits – is included on the Notice of Assignment. If you are the responding party, and if an answer is required, it is critical that you respond by the required deadline.
• Step 4: The hearing. At the hearing, the judge will allow both parties to present evidence supporting their side. This may include testimony and/or documents related to how your workplace injury or illness occurred, the severity and treatment requirements of your workplace injury or illness, and details about how this workplace injury or illness is preventing you from returning to work. The workers’ compensation judge will set a schedule for the submission of any other evidence. As the injured worker, you will typically testify at some point in your case. This may be just once or at more than one hearing. Representatives for your employer may testify as well. Who testifies and when they testify depends on “the type of petition, whom the law requires to submit evidence first, the WCJs case management rules, and your attorney’s advice.”
• Step 4: After the hearing. Depending on the details of your workers’ compensation case, more evidence is often required for the judge to make a decision. This may include medical records and additional testimony, which may take months to gather. As a result, the judge may schedule additional hearings. It is unlikely – although not impossible – that your workers’ compensation case will be resolved with just one hearing.
• Step 5: The decision. In disputed workers’ compensation cases, Pennsylvania law requires the judge to present their final decision in writing. As a result, you will not receive a decision from the judge at your hearing or any follow-up hearings. Instead, you and your attorney will be notified of the workers’ compensation judge’s decision via the mail or through the online Workers’ Compensation Automation and Integration System (WCAIS) after all evidence and briefs have been submitted to the judge.
• Step 6: Filing an appeal. Pennsylvania workers’ compensation law allows you to appeal the decision of a workers’ compensation judge to the Workers’ Compensation Appeal Board. There are strict time limits within which any appeal must be filed. This information will be provided on the workers’ compensation judge’s decision cover letter. If you are considering filing an appeal, it is best to discuss this with your Hanover workers’ compensation attorney as soon as possible after receiving the judge’s decision.

What types of workers’ compensation issues go before a judge?

A variety of petitions may go before a PA workers’ compensation judge, including:

• Claims
• Terminations
• Suspensions
• Modifications
• Reviews
• Medical Reviews
• Petitions Seeking Approval of a Compromise and Release
• Employee Challenges

If you or a loved one suffered a job-related injury or illness in Pennsylvania, it is imperative that you consult an experienced PA workers’ compensation lawyer. The adjudication process for workers’ compensation claims can be lengthy and complex, making it difficult to navigate without an attorney who knows and understands the system and all required deadlines. The Hanover workers’ compensation lawyers at KBG Injury Law can help. We know that most employers are not interested in doing the right thing for their injured or ill employees, so we fight to ensure you receive a positive outcome to your workers’ compensation claim. From our offices in Hanover, Harrisburg, Gettysburg, Lancaster, and York, we represent injured and ill employees in workers’ compensation cases throughout South Central PA. To schedule a free consultation, call us or complete our online contact form.