1. (a) An appeal or cross appeal shall be filed with the Board on a form provided by the Board. All references to forms mean paper forms or an electronic format prescribed by the Board and published in the Pennsylvania Bulletin or the Department’s web site located at www.dli.state.pa.us. All forms must contain the following information:

   1. (1) The name and address of the claimant, name and address of the defendant, date of the injury, type of petition, insurance carrier and circulation date of the decision at issue. An appeal from a workers’ compensation judge’s decision is deemed to include all claim numbers, dispute numbers and petition numbers referenced in the decision and order which are the subject of the appeal. This paragraph does not supersede the other requirements of this section.
   2. (2) 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.
   3. (3) A statement of the relief which is requested.
   4. (4) A statement whether the petitioner seeks an opportunity to file a brief or present oral argument or whether the case should be heard on the record without brief or oral argument.
   5. (5) Identification of the judge whose decision is in question, including as an attachment, a copy of that judge’s decision.
   6. (6) A proof of service as specified in § 111.12(e) (relating to filing, service and proof of service).
2. (b) An appeal or a cross appeal shall be served on all parties and the judge.
3. (c) A request for supersedeas, if desired, shall be indicated on the appeal and conform to § 111.21 (relating to content and form).
4. (d) Subsections (a)—(c) supersede 1 Pa. Code § § 31.5, 33.1—33.4, 33.11, 33.12, 35.17 and 35.20.

Authority

The provisions of this § 111.11 amended under sections 401.1, 435(a) and (c) and 1608 of the Workers’ Compensation Act (77 P. S. § § 710, 991(a) and (c) and 2708); section 2205 of The Administrative Code of 1929 (71 P. S. § 565); and section 414 of The Pennsylvania Occupational Disease Act (77 P. S. § 1514).

Source

The provisions of this § 111.11 adopted January 1, 1970; amended April 7, 1989, effective April 8, 1989, 19 Pa.B. 1631; amended December 6, 2002, effective December 7, 2002, 32 Pa.B. 6043; amended October 16, 2009, effective October 17, 2009, 39 Pa.B. 6038; amended December 19, 2014, effective December 20, 2014, 44 Pa.B. 7837. Immediately preceding text appears at serial pages (345966) to (345968).

Notes of Decisions

Referee’s Decision

Failure to attach a copy of the referee’s decision to an appeal will not provide the basis to strike an appeal to a Workmen’s Compensation Appeal Board when, due to clerical error, a copy of the decision was not available and the employer’s attorney attached letter stating the same. Smith v. Workmen’s Compensation Appeal Board, 632 A.2d 1033 (Pa. Cmwlth. 1993); appeal denied 644 A.2d 1205 (Pa. 1994).

Specificity

Appeals before the Workmen’s Compensation Appeal Board are governed by this regulation; therefore, employer could not succeed in framing its credit issue for the Workmen’s Compensation Appeal Board where employer made absolutely no mention of that issue in questioning the Workmen Compensation Judge’s conclusions. The employer waived its right to challenge that issue. Lewistown Hospital v. Workmen’s Compensation Appeal Board, 683 A.2d 702 (Pa. Cmwlth. 1996).

The employer’s notice of appeal to the Workers’ Compensation Appeal Board utterly failed to raise the claims of error with any degree of specificity and thus the claims have been waived for purposes of appeal, where the employer merely stated ‘‘2-10’’ on the appeal form to the Board, and such a cryptic assertion clearly does not specify the errors of law committed by the Workers’ Compensation Judge or why his decision does not conform to the provisions of the Workers’ Compensation Act. Jonathan Sheppard Stables v. Workers’ Compensation Appeal Board, 739 A.2d 1084 (Pa. Cmwlth. 1999).

Sufficient Particularity

Original counsel’s petition filed with the Workers’ Compensation Appeal Board for appeal nunc pro tunc for reinstatement of counsel fees challenging the Workers’ Compensation Judge’s fee award to subsequent counsel was raised at the at the appropriate time with appropriate sufficiency to preserve the issue before the Board; while the petition filed by counsel was not the typical appeal document, the procedural posture of this case was, itself, not typical as he was not a party to the WCJ’s decision. Hendricks v. Workers’ Compensation Appeal Board (Phoenix Pipe and Tube), 909 A.2d 445, N. 12 (Pa. Cmwlth. 2006).

The employer sufficiently specified issues upon which it based its notice of appeal by listing by number only, the findings of fact and conclusion of law at issue and no error of law was committed by Workmen’s Compensation Appeal Board in hearing the appeal. Garnett v. Workmen’s Compensation Appeal Board (Equitable Gas Co.), 631 A.2d 705 (Pa. Cmwlth. 1993); appeal denied 641 A.2d 312 (Pa. 1994).

Notice of appeal which identified findings of fact and law by number alone provided sufficient notice of the issues on appeal. Garnett v. Workmen’s Compensation Board of Appeal, 631 A.2d 705 (Pa. Cmwlth. 1993).

Timely Appeal

Workers’ compensation claimant did not file timely appeal and did not properly mail appeal of workers’ compensation judge’s decision when he sent appeal documents to the Bureau of Workers’ Compensation rather than to the Workers’ Compensation Appeal Board; appeal form instructed claimant to send appeal to the Board and Board’s mailing address was listed on top of the form. Ludwikowski v. Workers’ Compensation Appeal Board (Dubin Paper Co.), 910 A.2d 99, 101—102 (Pa. Cmwlth. 2006).

Waiver of Issue

It is clear that where none of the challenged findings of fact or conclusions of law referred to the employer’s first terminated petition, let alone the doctrine of res judicata, the claimant waived the res judicata issue. Williams v. Workmen’s Compensation Appeal Board, 687 A.2d 428 (Pa. Cmwlth. 1997).

Cross References

This section cited in 34 Pa. Code § 111.12 (relating to filing, service and proof of service); and 34 Pa. Code § 111.15 (relating to no other pleadings allowed).