34 Pa. Code § 111.11 - Content and form

(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) 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) 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) A statement of the relief which is requested.

(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) Identification of the judge whose decision is in question, including as an attachment, a copy of that judge's decision.

(6) A proof of service as specified in § 111.12(e) (relating to filing, service and proof of service).

(b) An appeal or a cross appeal shall be served on all parties and the judge.

(c) A request for supersedeas, if desired, shall be indicated on the appeal and conform to § 111.21 (relating to content and form).

(d) Subsections (a)-(c) supersede 1 Pa. Code §§ 31.5, 33.1-33.4, 33.11, 33.12, 35.17 and 35.20.

Notes

34 Pa. Code § 111.11

The provisions of this § 111.11 adopted January 1, 1970; amended April 7, 1989, effective 4/8/1989, 19 Pa.B. 1631; amended December 6, 2002, effective 12/7/2002, 32 Pa.B. 6043; amended October 16, 2009, effective 10/17/2009, 39 Pa.B. 6038; amended December 19, 2014, effective 12/20/2014, 44 Pa.B. 7837.

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).

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).