Appealing a Pennsylvania Workers Compensation Denial
Understand how to appeal your workers compensation denial in the state of Pennsylvania.
When you file a workers' comp claim in Ohio, the Ohio Bureau of Worker’s Compensation is required by state law to either allow or deny your claim within 28 days. The Bureau will send you written notification, known as a BWC Order, letting you know whether you claim was accepted or denied. (For more information, see our article on workers' comp basic in Pennsylvania.)
If your claim was denied, you can appeal that decision. On the other hand, if your claim was allowed but your employer disagrees that you were injured at work, or that you shouldn't get workers' comp benefits for other reasons, your employer can appeal the allowance of your workers’ compensation claim.
You must file an appeal with the Industrial Commission of Ohio within 14 days of the BWC Order. To file the appeal, you may complete an online form through the Industrial Commission Online Network (ICON). Or, you may file your appeal in written form using the “Notice of Appeal – IC-12” form. Send this form to the Industrial Commission service office nearest to your residence. (You can find the office locations at www.ohioic.com.)
The Industrial Commission will then send you notice of the place, date, and time of your hearing. The initial hearing will be a District Level Hearing.
District Level Hearing
Within 45 days of your initial appeal request, you will have a District Level Hearing. An Officer of the Commission will preside over the hearing. Written witness affidavits, and deposition transcripts are submitted to the Officer for review before the hearing. During the hearing, you and your employer or its insurance company may present witness testimony. You should be prepared to testify, and be prepared to present witnesses on your behalf, including your doctor and co-workers that witnessed the incident.
The Commission may require you to attend an independent medical examination while your case is pending at the District Level. You are required to attend this examination, but you have a right to review the examiner’s report.
The Officer will send a written decision to you and your employer no later than seven days after the hearing. Either party may appeal the decision to the Staff Level.
No later than 45 days after appeal decision from the District Level Hearing, the Staff Hearing Officer will conduct another hearing. The Officer will review the evidence presented and issue a written decision that will be sent to each party. If you lose, you can appeal to the Commission Level.
Unlike the first two levels of appeal, the Commission Level is not guaranteed. The Commission will review your appeal request and the Staff Hearing Officer’s decision and decide whether or not to grant the appeal.
If the Commission denies the appeal request, the Staff Hearing Officer’s decision may be appealed to the state courts of Ohio within sixty days from the Commission’s denial.
Alternatively, if the Commission accepts the appeal, the Commission will conduct a hearing within 45 days of the appeal from the Staff Level. The Commission will issue a written decision no later than seven days after the hearing. Either party may appeal to the state courts of Ohio.
The appeals process is a legal process, and is most easily navigated with the help of an experienced workers’ compensation attorney. Your employer will have experienced legal counsel, and you will be served by having an attorney to advocate on your behalf.