Instructions for Completing the Appeal Form

 
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  1. You have 20 calendar days from the Circulation Date to appeal a Judge’s Decision.
     
    • Circulation Date is listed on the front page of the Judge’s Decision.
    • Timeliness of the appeal is based upon the U.S. Postal postmark on the envelope.
    *The appeal must be POSTMARKED by the 20th day from the date of circulation.
  2. Attach a copy of the completed Judge’s Decision to the original appeal.
     
    •  (Include the front page which lists the Circulation Date)
     *Additional copies of the appeal do NOT require an attached Judge’s Decision.
  3. Complete the PROOF OF SERVICE page:
     
    • List ALL parties, with names and addresses, that appear on the circulation sheet of the Judge’s Decision. (Including the Judge)
    • Mail a copy of the Appeal to ALL parties that are listed.
     
  4. Check ALL information on the appeal form for completeness:
     
    • Petition Type (listed on circulation sheet)
    • Circulation Date
    • Social Security Number
    • Bureau Claim Number
    • Date of Injury (original date that injury occurred)
    • Addresses
    • Alleged findings (Be specific in listing the reasons for appeal and state why you feel the Judge was wrong in his/her decision.)

      “A statement of the particular grounds upon which the appeal is based, including reference to the specific findings of fact which are challenged and the errors of the law which are alleged. General allegations which do not specifically bring to the attention of the Board the issues decided are insufficient.”
     
    • Proof of Service
       
  5. Mail the ORIGINAL appeal plus 2 copies to:
      Workers’ Compensation Appeal Board
      Capitol Associates Building
      901 North 7th Street – 3rd Floor South
      Harrisburg, PA 17102-1412
  6. Revisions to the WCAB Rules of Practice and Procedure, effective October 17, 2009, provide for the electronic filing of an appeal. At the present time, electronic filing is not available. This website will be updated once it is available.
Any additional questions? Call the Appeal Board at (717) 783-7838.
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