PERSONA
ADDRESS
Notice
RE:
PERSONA SD (WCAB) Temporary Docket No.: __________________
The Court has received your recent communication indicating your intention to appeal from a decision of the agency listed at the end of this notice. The Pennsylvania Rules of Appellate Procedure (Pa.R.A.P.) require that in order to perfect your appeal you must file a petition for review with this Court. This notice and the enclosed forms will and provide important information about filing a petition for review; please read them, carefully follow all instructions.
The date of December 17, 2021 will be preserved as the date of filing your appeal. This is the date your communication indicating your intention to appeal was filed with this Court. If this date is more than 30 days from the mailing date of the decision that you are appealing, your appeal may be dismissed because it is untimely. In addition, unless your petition for review is filed and the filing fee (if any) is paid within 30 days of the date of this notice, the Court will take no further action in this matter. See Pa.R.A.P. 121, 1512, 1514; Commonwealth Court Internal Operating Procedures § 211.
A blank petition for review form is enclosed for you to complete and return to the Court. Also enclosed are a blank cover letter form and a blank proof of service form. All pages of the enclosed forms must be completed legibly, signed, and returned to the Court as directed below.
The petition for review must include a general statement of objections to the order or other determination that you are appealing. See Pa.R.A.P. 1513.
Any time you file papers with the Court, including your petition for review and all subsequent filings, you must send a copy to all other parties and provide a proof of service to the Court. In this case, you must send copies of your completed and signed petition for review (all pages) to 1) the agency, 2) the Attorney General of Pennsylvania, and 3) all other parties who participated before the agency. You may serve these copies by certified mail or personal delivery. A proof of service, which states that you have served the other parties and the Attorney General, and lists the addresses that you used to serve the papers, must be attached to all papers that you file with the Court. See Pa.R.A.P. 121, 122, 1514(c).
In addition, any time you file papers with the Court, the papers must be accompanied by a certification of compliance with the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania (Public Access Policy). See Pa.R.A.P. 127. The Public Access Policy and related forms and information are available
It is very online at http://www.pacourts.us/public-records/public-records-policies. important that you review and follow the Public Access Policy because it requires you to protect sensitive personal information in Court filings.
Unless protected by the Public Access Policy or otherwise sealed by statute or court order, all dockets, filings, and orders and opinions of the Court in your case will be public records and subject to public inspection. The Court’s public dockets are available on the Court’s website and are searchable on–line. The Court’s opinions, which generally include a summary of the case, including the identity of the parties and the relevant factual background, also are available on the Court’s website and searchable on–line. Generally, the Court will seal or restrict public access to dockets or opinions only in accordance with the Public Access Policy or upon motion and order of Court for good cause.
Because this is an appellate court, its function is limited to reviewing the record made before the agency. The Court cannot consider any new evidence. The agency will send us the original record of your case. When the Court receives the original record, we will notify you when your brief is due. A brief is a written argument explaining your legal position. You will need to file four copies of your brief. Depending on the nature of your case, you also may need to file four copies of a reproduced record. See Pa.R.A.P. Chapter 21.
The Pennsylvania Rules of Appellate Procedure (Pa.R.A.P.) and the Commonwealth Court Internal Operating Procedures are available in any county law library or online at http://www.pacode.com/secure/data/210/210toc.html. You may wish to consult with a lawyer. If you do not have a lawyer, you may wish to contact the bar association lawyer referral service or the legal aid service in your county. These services can provide you with information about hiring a lawyer, or may be able to provide you with information about agencies that may offer legal services to eligible persons at a reduced fee or no fee. If you have general questions about the information in this notice, you may go to the Court’s web page at www.pacourts.us or call the Prothonotary’s Office at 717- 255-1650. If you call, please have this notice handy and refer to the temporary docket number (XX) at the top of this notice. The Prothonotary’s Office cannot give you legal advice.
This is what you must file with this Court at the address below within 30 days of the date of this notice to perfect your appeal:
(1) the original and one copy of your completed and signed cover letter and petition for review (use the enclosed forms and legibly complete all information on all pages);
(2) the certificate of compliance with the Public Access Policy;
(3) the proof of service signed by you, which states that you have sent a copy
of the petition for review to the agency, the Attorney General, and all other parties, and lists the addresses that you used to send the petition for review (use the enclosed form and legibly complete all information); (4) a copy of the agency decision that you are appealing;
(5) a copy of this notice; and
(6) the filing fee, if any, shown below. The filing fee may be paid by check or
money order payable to the Commonwealth Court of Pennsylvania.
Mailing address of the Court:
Prothonotary
Commonwealth Court of Pennsylvania 601 Commonwealth Avenue, Suite 2100 P.O. Box 69185
Harrisburg, PA 17106-9185
Agency: Workers‘ Compensation Appeal Board
Filing Fee: $90.25
Enclosure
PERSONA
ADDRESS
- The Board failed to acknowledge, consider, and/or recognize circumstantial evidence proving that the Petitioner
suffered the shoulder injury consequential and incidental to the incident on February 19, 2019. It is trite law that Circumstantial
evidence is reviewed by the same standards as direct evidence. (Monad v. Stale Horse Racing Comm’n, 717 A.2d
612, 618 (Pa.Cmwlth. 1998)). Further, When properly proved, circumstantial evidence is entitled to as much weight as
direct evidence. In Lilley v. Johns-Manville Corp., 408 Pa.Super. 83, 93, 596 A.2d 203, 207 (1991), the Court observed
the nexus between a specific asbestos product and a plaintiff’s medical condition may be supplied by a variety
of of direct and circumstantial evidence. Further, in Monaci v. State Horse Racing Comm’n, 717 A.2d 612, 618 (Pa.
Cmwlth. 1998) (citation omitted), the Court held that Circumstantial evidence is “evidence of one fact or of a
or of a set of facts from which the existence of the fact to be determined may reasonably be inferred.
In light of the foregoing, the Petitioner avers that the Board failed to accord Petitioner’s Circumstantial the weight it deserves
under the aforesaid law. Notably, the Petitioner has presented a statement where she outlines how she complained of pain
in her shoulders. First, in Petitioner’s testimony before the Judge, the Petitioner notes how her shoulders started to feel
to feel “stiff and achy” a moment after the incident on February 19, 2019. She notes in her testimony that she indeed
complained of pain in her shoulders but none of the medical practitioners she visited at first, took note of her concern.
On or about May 24, 2019, the Petitioner reported to Dr. Pereira of her pain on her right shoulder. Dr. Pereira recommended
the Petitioner be removed from work, from May 25 to June 14, 2019. Petitioner further avers that the fact that Dr. Grodofsky
noted the full thickness rotator cuff tear after the re-evaluation on July 25, 2019, does not mean that Petitioner did not suffer
the injury on the February 2019 incident. That notwithstanding, the Doctor noted that the shoulder tear restricted the Petitioner.
Petitioner also avers that the Judge and the Board erroneously considered the testimony of Dr. Murphy, who had only met
and examined Appellant once, and the meeting was brief. In light of the foregoing, the Petitioner avers that the Board
erred in failing to consider circumstantial evidence that showed that Petitioner indeed suffered the injuries on her shoulders as a result of the incident on February 2019. 2. There was no Substantial evidence to support the Judge and the Board’s holding that the shoulder injury was not
related to the February incident. It has been held that substantial evidence is that which constitutes such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion. (Gamble v. Workmen’s Compensation Appeal
Board (Burrel Construction and Supply Co.) 598 A 2d 1073 (Pa.Cmwlth. 1991). It involves more than a scintilla of evidence or
suspicion of the existence of a fact to be established. (Bobchock v. Unemployment Comp. Bd. of Review, 525 A 2d 463,
465 (Pa. Cmwlth. 1987). Accordingly, Petitioner avers that there is no evidence to support the holding that the Petitioner’s shoulder injury was not as a result of the February incidence.
- WHEREFORE, Petitioner prays that this Court review and set aside the order and grant relief as may be just and proper.
(Your signature)
(Your printed name)
(Your street address)
(City, State, and zip code)
(Your telephone number)
(Today’s date)
NOTICE TO PARTICIPATE (Pa.R.A.P. 1513(d)) [This notice is for any other party to the proceedings conducted by the government agency/board/office/department who is not named as a respondent.
You must send a copy of the entire Petition For Review (pages 1-5) to all such other parties.]
You have not been named as a respondent; however, you were a party before the government agency/board/office/department whose decision is sought to be reviewed.
If you intend to participate in this proceeding in the Commonwealth Court, you must file and serve an Application for Intervention or a Notice of Intervention under Rule 1531 of the Pennsylvania Rules of Appellate Procedures within 30 days.
Page 3 of 5
[Legibly complete and return all pages.]
Pro Se PFR – Gen.
Rev. 7/2019
CERTIFICATE OF COMPLIANCE
I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania that require filing confidential information and documents differently than non–confidential information and documents.
Submitted by:[
Signature:
Name:
Attorney No. (if applicable):
[Case Records Public Access Policy of the Unified Judicial System of Pennsylvania – Any time you file papers with the Court, the papers must be accompanied by a certification of compliance with the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania (Public Access Policy). Pa.R.A.P. 127. The Public Access Policy and related forms and information are available online at http://www.pacourts.us/public-records/public- records–policies. It is very important that you review and follow the Public Access Policy because it requires you to protect sensitive personal information in Court filings.]
Page 4 of 5
[Legibly complete and return all pages.]
Pro Se PFR- Gen.
Rev. 7/2019
PROOF OF SERVICE
I certify that I sent by certified mail, return receipt requested, a true and correct copy of the Petition for Review (pages 1-5) to these parties:
(1)
Government Agency/Board/Office/Department (Name and address):
(2)
(3)
Attorney General of Pennsylvania
16th Floor, Strawberry Square
Harrisburg, PA 17120
Other party, if any, to the proceedings conducted by the government agency/board/office/department who is not named as a respondent (Name and address):
(Attach additional pages as needed for additional parties.)
(Your signature)
(Your printed name)
(Your street address)
(City, State, and zip code)
(Your telephone number)
(Today’s date)
NOTE: You MUST file the original and one copy of the entire Petition for Review (pages 1-5) with the Prothonotary of the Court at the mailing address on Page 1 of this form, AND you MUST send copies of the entire Petition for Review (pages 1-5) to all other parties as indicated above.
Page 5 of 5
[Legibly complete and return all pages.]
Pro Se PFR- Gen.
Rev. 7/2019
At Legal writing experts, we would be happy to assist in preparing any legal document you need. We are international lawyers and attorneys with significant experience in legal drafting, Commercial-Corporate practice and consulting. In the last few years, we have successfully undertaken similar assignments for clients from different jurisdictions. If given this opportunity, we will be able to prepare the legal document within the shortest time possible.