INSTRUCTIONS AND PROCEDURES
• In order to request an informal conference, you must obtain the agreement of all parties in your matter to participate in
the informal conference.
• To le this form, mail original to the workers’ compensation judge (adjudicating judge) who has the assigned petition.
If there is no pending petition and one is attached, then le it with the Workers’ Compensation Ofce of Adjudication,
1010 N. Seventh St, Suite 202, Harrisburg, PA, 17102-1400. This form may be led with the signature of a
representative of only one party, but only with the knowledge and consent of all parties.
• The adjudicating judge is the workers’ compensation judge who has been assigned to hold hearings and issue decisions
relating to a petition(s).
• The parties may suggest an informal conference judge or hearing ofcer, but the assignment will be made by the judge
manager from the district where the claim is pending.
• The informal conference judge or hearing ofcer will assign a date, location and time for the informal conference to be
held within 35 days of ling of the request and may request information from the parties seeking an informal conference.
• There shall be no time extension without written agreement of all the parties which shall be led with the informal
conference judge or hearing ofcer.
• The adjudicating judge shall not be assigned to an informal conference.
• “All communications, verbal or written, from the parties to the workers’ compensation judge or hearing ofcer and any
information and evidence presented to the workers’ compensation judge or hearing ofcer during the informal conference
proceedings are condential and shall not be a part of the record of testimony.” WC Act, 402.1(b)(ii).
• “Each party may be represented, but the employer may only be represented by an attorney at the informal conference if
the employee is also represented by an attorney at the informal conference.” WC Act, 402.1 (b)(iii).
• All participants at the informal conference must have authority to resolve the matter in controversy.
• The informal conference judge or hearing ofcer conducting the informal conference may meet separately with each of
the parties during the conference and may use other reasonable means to encourage an informal resolution.
• If the parties resolve the petition(s), the party who led the pending petition(s) must notify the adjudicating judge that
the petition(s) is (are) resolved.
• The informal conference judge or hearing ofcer conducting the informal conference shall reduce the agreement reached
to writing which will be signed by the parties. The original informal conference agreement and attached documents shall
be led with the adjudicating judge with the copy to the informal conference judge or hearing ofcer.
• If the informal conference does not resolve the case, it will be returned to the assigned adjudicating judge. The parties
may jointly request the adjudicating judge to reassign the case to the workers’ compensation judge who conducted the
informal conference if the conference was held by a workers’ compensation judge subject to WCOA approval.
• Parties may agree to pursue the Compromise and Release procedures as a result of the informal conference through the
adjudicating judge, but the Compromise and Release Agreements will not be accepted at informal conferences.
Any individual ling misleading or incomplete information knowingly and with the intent to defraud is in violation of Section 1102 of the Pennsylvania Workers’ Compensation Act,
77 P.S. §1039.2, and may also be subject to criminal and civil penalties under 18 Pa. C.S.A. §4117 (relating to insurance fraud).
Employer Information Claims Information Services Email
Services toll-free inside PA: 800.482.2383 ra-li-bwc-helpline@pa.gov
717.772.3702 local & outside PA: 717.772.4447
Hearing Impaired
PA Relay 7-1-1
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Auxiliary aids and services are available upon request to individuals with disabilities.
Equal Opportunity Employer/Program
LIBC-753 REV 04-18 (Page 2)