Can You Appeal a Denied Workers’ Comp Claim in Pennsylvania?

Before you decide to appeal the decision made in your Workers’ Compensation case, it is strongly recommended that you review the Decision with your Philadelphia Workman’s Comp Lawyer to determine if they will be taking an appeal and why or why not. If  you were represented by an attorney who does not wish to appeal,  you may appeal it yourself or try to find another attorney. However, this can be a difficult task because of several reasons: 1) A new attorney is unlikely to want a case that has already been rejected by a Work Comp Judge, 2) 20 days can go by quickly and it is difficult to catch up to speed on a case that fast, and 3) the legal burden to overturn a decision from a Work Comp Judge is fairly strenuous. This is not to say that you should simply accept the Decision of the Work Comp Judge, but it is to say that it is usually difficult to find a new attorney who will want to jump onboard.

Can You Appeal a Workers’ Compensation Denial?

Yes. If you wish to appeal part of all of a Decision that was unfavorable to you, you have a right to appeal within 20 days of the date of the decision. (20 calendar days, not business days)

Who Hears the Appeal?

The appeal is heard by the Workers’ Compensation Appeal Board (WCAB).  The Board is primarily an appellate body review Judge’s decisions on legal issues, but sometimes has original jurisdiction. The Board consists of at least three, but a max of 15 members appointed by the governor.

Procedurally, once the appeal is filed, an oral argument is scheduled. The moving party is to submit its Brief at the hearing, and usually extra time is permitted for the responding party, to submit its Brief. Then the parties submit their Briefs and await a decision, which can take 6 to 12 months approximately.

There are various bases on which to file an appeal to the WCAB.  You can assert that the decision is not in conformity with the terms of the Pennsylvania Work Comp Act.  Another basis is that the WCJ committed an error of law. You can argue that the findings of fact are not supported by sufficient, competent evidence. Another avenue is asserting that the findings of fact or decision was procured by coercion, fraud, or the improper conduct of a party. A rather common basis to appeal is alleging that the Decision is not a “reasoned decision” which provides for meaningful appellate review.

The Scope of Review of the WCAB is the same as the Commonwealth Court (the Court above the WCAB)- the WCAB can look into whether any conclusions are errors of law or whether the findings support legal conclusions. The WCAB can also determine if the reasoned decision standard was met.

Are You Likely to Win an Appeal?

Practically speaking, it is quite difficult to get the WCAB to overturn a Decision. If there are facts which support the conclusions, the decisions tend to be affirmed. Many claimants believe that if there are also facts that support his or his case, that the WCAB will reverse the decision. This is not true. If there is sufficient, competent evidence supporting the findings, even if there is some evidence supporting the claimant’s case, the decisions will be affirmed. The WCAB is bound by the credibility determinations made by the WCJ (Judge).  Unless there is an abuse of discretion, those determinations won’t be overturned by the WCAB. What is more common is a remand-which means the WCAB sends the case back to the WCJ to re-issue the decision, commenting on evidence that may not have been considered or weighed properly.

This is not to say that appeals are a waste of time. Indeed, some appeals are successful and end up changing the law via the Commonwealth Court or Pennsylvania Supreme Court. And, sometimes, the mere filing of an appeal can help settle a case. Each case must be evaluated on its own merit.

It is more common to see a “remand” where the Appeal Board sends back a case to the Work Comp Judge to re-issue the Decision, with a more detailed review of specific evidence or a more detailed analysis of the reasoning behind a credibility determination. Some cases get overturned, but I imagine the number to be a small percentage.

Can an Attorney Help Your Case?

I get a few calls every month from injured workers who lost their case, but who were unrepresented (“pro se”) or had another attorney, and want me to file an appeal. I do not take many of these cases but I will review the case with an injured worker and share my thoughts. The key is to listen to your attorney during the litigation process and to ask him or her to tell you the strengths and weaknesses of the case and to give an approximate range as to the odds of success. Given the highly deferential nature of the appeal law, the time to communicate carefully with your Pennsylvania Work Injury Lawyer is before a Decision is rendered- and to take any recommendation of settlement seriously. Litigation is always unpredictable. That doesn’t mean you should settle just to settle- the settlement, of course, has to be fair given the facts of your case. But counting on a victory is never a wise thing to do either.

If you would like more information about Workers’ Compensation, call or email us 7 days a week at (215) 206-9068.