The Flow Of A Pennsylvania Workers' Compensation Claim (Page 2 of 2) in pdf

The Flow of a Pennsylvania Workers’ Compensation Claim

(Litigated)

Employers are required to post form LIBC-500, Remember: It is Important to Tell Your Employer

About Your Injury, to inform employees of the name, address and phone number of their

Notice of Injury

workers’ compensation insurance company, their third-party administrator or internal workers’

compensation contact person.

An employee injury is to be reported to the employer within 21 days; if not reported within 120

Injury

days from the date of injury or having knowledge of a work-related disease, no compensation is

allowed (except for cases involving progressive diseases).

Employers are required to immediately report all employee injuries to their insurer or, if self-

insured, to report them to the person responsible for management of the employer’s workers’

compensation program. Employers are also required to file a First Report of Injury (formerly the

First Report of Injury

Employer’s Report of Occupational Injury or Disease) with the Bureau of Workers’ Compensation

within 48 hours for every injury resulting in death, and within seven days for all other injuries

that result in disability lasting more than a day, shift or turn of work. This document must be

submitted electronically.

Within 21 days from the date the employee provides notification of an injury, the employer/carrier

accepts liability for the injury and issues a Notice of Workers’ Compensation Payable, a Notice of

Temporary Compensation Payable or an Agreement for Compensation to the employee. These

Voluntary Payment

paper form and EDI transactions must also be filed with the Bureau of Workers’ Compensation.

See the Flow of a Pennsylvania Workers’ Compensation Claim on page 3 for more detailed

information.

Within 21 days from the date the employee provides notification of an injury, the employer/carrier

Denial of Payment

denies liability and issues a Notice of Workers’ Compensation Denial to the employee; the Denial

and appropriate EDI transaction must also be filed with the bureau.

Generally, the employee has three years from the date of injury to file a Claim Petition (LIBC-

362). The law also provides that injured workers may reopen their claim within three years from

Employee Files Claim Petition

the last date an indemnity payment was made on a claim. (Mere paying of medical benefits would

not be the same as reopening the claim.)

Workers’ compensation petitions are normally assigned to a workers’ compensation judge

Case Assigned to Workers’

according to the county in which the employee lives. A Notice of Assignment is issued to the

Compensation Judge

parties advising them as to which judge is assigned to the matter.

Workers’ Compensation

Once assigned, all parties involved in the case are notified as to the date, time and place of

Hearing Scheduled

hearing.

A workers’ compensation judge hears and receives evidence presented by both the defendant

Workers’ Compensation

(employer/insurer) and claimant at one or more hearings that may be extended by the need to

Hearing Held

obtain medical evidence and hear other witnesses.

The workers’ compensation judge will schedule the case for mediation, unless the judge concludes

Workers’ Compensation

it would be futile. If this mediation does not take place or lead to settlement, the parties may at

Alternative Dispute Resolution

any time ask for an informal conference or settlement conference with a workers’ compensation

Session Held

judge.

A written decision is circulated to involved parties after a case is closed (all evidence has been

Decision Rendered

submitted and the judge has everything necessary to render a decision). No further action is

taken.

Either party has 20 days from the date the workers’ compensation judge’s decision is circulated to

Appeal Made to Workers’

Compensation Appeal Board

all parties to file an appeal with the Workers’ Compensation Appeal Board.

Either party has 30 days from the date of publication of the Workers’ Compensation Appeal

Appeal Made to

Board’s opinion to file an appeal with the Commonwealth Court.

Commonwealth Court

Appeal Made to Pennsylvania

Either party has 30 days from the date of publication of the Commonwealth Court’s decision to file

a Petition for Allowance of an Appeal with the Pennsylvania Supreme Court.

Supreme Court

The Flow Of A Pennsylvania Workers' Compensation Claim Page 2

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