Summary to date:
Barbara Woods injured her back, eye and arm at work. The workers’ compensation insurance company agreed to pay medical bills for some of her injuries and temporarily paid weekly workers’ compensation. The payment by a Notice of Temporary Compensation Payable was revoked (stopped). She hired Attorney Matt Kaminsky who filed a Claim Petition. Todd, her boyfriend, then calls Matt to find out what happens next. Matt first checks with Ms. Woods to make sure that she authorizes him to speak with Todd. Matt then explains the next step in the case to Todd.
Definition of terms:
Defense Attorney – The opposing lawyer who represents the employer and the WC insurance company.
Claim Petition – a special form which contains all the important aspects of Barbara’s claim.
Appearance – an attorney registers with the Judge in a particular case,
Service – mailing copies of all official documents filed to everyone listed within the claim. (The claimant, employer, defense attorney, insurance carrier)
Answer – A response filed by the attorney for the insurance company (defense attorney)
Bureau – the Bureau of Workers’ Compensation in Harrisburg, PA.
The Claim Petition is filed electronically through the Workers’ Compensation Automation and Integration System (WCAIS).
Here are the requirements for logging on to WCAIS and filing a Petition.
- An attorney or a Claimant can enter their appearance by listing the date of injury and social security number, or the WCAIS number and date of injury.
- An attorney can enter their appearance for Claimants. This was done in Ms. Woods’ case.
- Once an appearance has been entered, the attorney is able to access the official documents which the adjuster has filed with the Bureau. From this location, Attorney Kaminsky is able to file Petitions in the case. There are other petitions other than a Claim Petition which can be filed, such as a Petition for Reinstatement, Petition for Review, Petition for Penalties and Petition for Review of a UR Determination. We will be discussing these Petitions in future chapters.
- It is very important that the attorney notify all of parties listed in the case. A copy of the Petition and the Certificate of Service is available within WCAIS for serving all of the parties.
Once the Claim Petition is filed, the Petition section of the Bureau of Workers’ Compensation assigned the Petition to a Workers’ Compensation Judge. Petitions are signed to Judges based on the Claimant’s county of residence in Pennsylvania.
Barbara will receive different forms from the Bureau of Workers’ Compensation including an Assignment to Judge and a Hearing Notice. Once the Petition is circulated to the insurance company, the attorney for the insurance company has 20 days to file an Answer. These are usually boilerplate meaning that the defense attorney denies everything in the Claim Petition.
Barbara’s case has now been assigned to WC Judge Smith. He is a civil service employee hired by the Commonwealth of Pennsylvania. Neither Barbara nor ACME can request a change of Judge unless there is a very good reason. A Pre-trial hearing has been scheduled to occur in Harrisburg, PA. Barbara, Attorney Kaminsky and the defense attorney attend. Sometimes, the employer shows up.
There are usually at least three hearings in the average workers’ compensation case. 1) A pre-trial hearing for the Judge to set up the schedule / time table of the case. 2) A second hearing four to eight weeks later for Barbara to testify. Both Attorney Kaminsky at Attorney Gunstadt (attorney for ACME) will be asking questions. 3)A third hearing is usually a final hearing for testimony from any employer witnesses.
In the meantime, Barbara has 90 days from the first hearing to submit evidence from her doctor. The attorney for ACME has 90 days thereafter to submit medical evidence from their doctor.
There are rules and deadlines involved which are contained in the Special Rules of Practice and Procedure before WC Judges. Although WC is supposed to be a prompt and non technical source of payments for workers’ injured on the job; in reality, the average WC case takes a year to litigate and be decided measured from the date the Claim Petition was first filed.
In addition, Judge Smith will have special rules of his own on how he wants cases handled in front of him. Thus, WC litigation involves complicated law, rules, regulations and directions. It is like football. You don’t just kick the ball and run down the field. There are rules to it.
NEXT: Getting ready for the pre-trial hearing!