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How workers’ compensation cases get decided

Workers' compensation

A worker who is hurt on the job in Pennsylvania is entitled to receive workers’ compensation benefits. These generally include medical benefits and wage loss benefits to help you while you are unable to do your job.

However, workers’ compensation claims are sometimes denied. Employers and their insurance carriers may dispute the extent of your injuries or argue that they weren’t work-related.

That’s why you need an experienced workers’ compensation lawyer on your side. An attorney can gather evidence and build a strong case that establishes you should receive benefits. Then your lawyer and the insurance company can try to negotiate a settlement to resolve your case so that you get the benefits you deserve.

But there are times when a settlement can’t be reached. What happens next?

Both sides prepare briefs.

Attorneys for each side will prepare briefs explaining their legal arguments for their position. In these briefs, each attorney will summarize:

  • The applicable laws
  • The facts of the case
  • Arguments about how the facts support their position

These briefs are submitted to the Pennsylvania Bureau of Workers’ Compensation.

A judge makes a decision.

The judge assigned to the case will carefully review the briefs to determine:

  • If there was an actual work injury
  • The seriousness of the injury and any disability it caused
  • How much the claimant has recovered from the injury
  • The effect of the injury on the worker’s ability to earn a living
  • Any necessary medical treatment for your injury
  • The credibility of medical evidence provided by the parties

After assessing all of the information presented, the judge will issue a written decision that includes thoughts on the credibility of the claim and the reliability of the evidence presented. It’s possible that both sides will accept the decision. If they don’t, there are other options.

Either side can appeal.

Both parties can appeal the judge’s decision to the Workers’ Compensation Appeals Board within 20 days. A hearing will be scheduled with the board. Members of the board will review the briefs that were prepared for the original judge. They will also hear oral argument from attorneys for each side. The board will then mail their decision to both parties. The entire process can take anywhere from 6 to 12 months.

Either side can go to court.

If either side is not satisfied with the board’s decision, they can appeal to the Commonwealth Court of Pennsylvania. However, the rules in court are much more stringent than in the Bureau of Workers’ Compensation. The case could ultimately be decided by the Supreme Court of Pennsylvania, though this is rare.

It is also possible for both sides to reach an agreement at any point in the process.

Workers’ compensation claims in Pennsylvania can be complicated. Employers and insurance companies often hire attorneys to protect their interests. You need an experienced lawyer who will fight for your rights. If you’ve been hurt on the job, contact the Law Offices of Richard A. Jaffe, LLC to schedule a free case evaluation.

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