How To File A Petition For Penalties Form Online

by admin on April 3, 2012

An injured employee or their attorney can file a Petition for Penalties with the Pennsylvania Bureau of Workers’ Compensation online if the workers’ compensation benefit checks or injury related medical bills have not been paid in a timely manner.

The process itself is relatively simple, but you will need to have all of the required information on hand due to time constraints (for security purposes), the form will close if too much time lapses between entering different information. And there are two parts.

Part 1: A Petition of Penalties form requires the following information:

  1. Social Security number of employee
  2. Date that injury occurred on
  3. Specific PA BWC Claim number (This is also known as a Bureau Claim number and is found on the left portion of any hearing notice. If you have a Notice of Compensation Payable or Denial, or a Supplemental Agreement for Payment of Compensation, than the claim number can be found under the insurers information. If there has been no official litigation than there may be no claim number, in this case leave the space blank).
  4. Basic Employee Information:
    • Name
    • Address
    • Telephone Number
    • County
  5. Information of Employer
    • Name
    • Address
    • Country
    • Telephone number
    • Bureau code, country, and FEIN number can be left blank if you don’t know that information
  6. Information of Insurer
    • Name
    • Address
    • Country
    • Telephone Number
    • Bureau code, county , and FEIN number can again be left blank if you don’t have access to that information. (It can be found on hearing notices, Notice of Compensation Payable or Denial, and Supplemental Agreement for Compensation).
    • Policy claim number (not the same as BCN number)
  7. Complete description of injury-suffered or cause of death. Put your name in the blank space, and list the part(s) of the body that was injured and diagnosed as such. If you have an occupational disease then you can check the corresponding box off.
  8. A complete description of what the insurer has failed to pay out. (Example: The insurer failed to pay workers’ compensation benefits from (date to date). The insurer failed to pay for medical treatment for the care provided by Dr.________ for the dates of service_______. You have the legal right to request fifty percent penalties, interest, costs, and lawyer fees (if you have one).
  9. Attorney for the employer and/or insurance company. Complete the name of the attorney and the corresponding information such as law firm, address, and phone number. If you don’t know this information than these spaces can be left blank.
  10. The one petitioning (either the employee or attorney) must enter their full name, address, phone number, and date of filing.

Part 2: Once you have all of the above listed information, then you are ready to start filing the petition. When doing so follow these steps:

  1. Log onto the Labor & Industry home page at www.dli.state.pa.us
  2. Scroll down on this page until you reach the picture of the hand x-ray, and then click on the one labeled with “Workers’ Compensation”.
  3. You will be directed to the Bureau of Workers’ Compensation page
  4. Click on the button titled “Claims Information” in the column to the left, a drop down menu should then appear.
  5. Click on the button labeled “Petition of Penalties”
  6. You will be directed to the Petition of Penalties page.
  7. In the center of the page, click on the button labeled “Petition for Penalties Electronic Submission”
  8. The Electronic Filing of Petition for Penalties page will then appear. At the bottom of the page there will be a box titled “Proceed”. Click this box.
  9. The login page for Electronic Filing will appear. If you don’t have an account to login with, click on the button titled “Don’t have a PA login Account?” and complete the application box. Be sure to include your full name, telephone number, email, and choice of user login ID. After doing all of this hit the continue button at the bottom of the page.
  10. Using the information that you compiled in Part 1 of this process, you can now complete the form for Petition for Penalties.
  11. When you are completed filling out the petition, click the submit button at the bottom of the page.
  12. A page will appear showing confirmation and give you the opportunity to print a copy of the petition out for your records. Click the document to open it, and the use the print button in the upper left side of your screen to print a copy out.
  13. You can print the confirmation page by using the same method. Whether or not you decide to print the page, if it has appeared on your screen then your petition has been received by the Bureau. It will then be processed and listed for a hearing before a Workers’ Compensation Judge.
  14. You can now close the program, once you do so you will not be able to reopen your specific document through the Bureau website.

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