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Instructions for Completing the Appeal Form

  1. When to file: An appeal of a Workers’ Compensation Judge’s decision must be made to the Board no later than 20 calendar days from the Circulation Date of the Judge’s Decision.
      • Circulation Date is listed on the front page of the Judge’s Decision.
      • Timeliness of the appeal is based upon either date of filing electronically through WCAIS or the U.S. Postal Service postmark on the envelope. The appeal must be POSTMARKED by the 20th day from the date of circulation.

2.  How to file: An appeal can be filed electronically using WCAIS, or by mail.

      • If filing electronically, follow the instructions provided by WCAIS.
      • If filing by mail, use this form and attach a copy of the completed Judge’s Decision to the appeal. (Include the front page which lists the Circulation Date). Mail the appeal to the following address:

Workers’ Compensation Appeal Board

1171 S. Cameron Street, Room 120B

Harrisburg, PA 17104

Mail a copy of the appeal to all parties of record, including the Judge.

3. Check ALL information on the appeal form for completeness:

  • Petition Type (listed on circulation sheet)
  • Circulation Date
  • 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 believe the Judge was wrong in his or 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

Any additional questions? Call the Appeal Board at 717-783-7838.