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Understand the adjudication process for workers’ comp claims

Published on Apr 24, 2020 at 5:53 pm in workers' compensation.

The Pennsylvania Department of Labor and Industry explains what workers injured on the job can expect in the workers’ compensation adjudication process.

Our firm has helped injured workers manage the complexities of moving through this process.

The adjudication process starts with a petition

You, your employer or the insurance company may demand adjudication to handle disputes related to your claim for workers’ compensation benefits:

  • A determination of your eligibility for benefits.
  • Challenges to your employer’s decision to terminate, suspend or modify benefits.
  • A review to fix mistakes in documents that describe your injury or wages.
  • An analysis of health care records to determine if medical treatment is reasonable, necessary and related to your work injury.

The parties may initiate adjudication by filing a petition with the Workers’ Compensation Office of Adjudication.

A judge will control the adjudication process

After filing of a petition, the WCOA will assign a judge to your case. The judge may require you and your employer to testify at one or more hearings. When the judge schedules a hearing, you must attend unless you seek and receive a postponement for good cause. The court will evaluate the testimony and review medical records, depositions and other documents relating to your injury and treatment. The parties also usually file legal arguments called briefs.

The judge will need some time to consider the evidence and issue a written decision. If you disagree with the judge’s decision, you may have the right to appeal within a certain time frame. Your workers’ compensation benefits may vary based on your injury’s seriousness and how long it keeps you from the workforce. Our website provides additional information about the workers’ compensation process.

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