All Pennsylvania Workers Compensation forms

Workers Compensation - Answers

• Defendant's Answer to Claim Petition under Pennsylvania Occupational Disease Act for Workers' Compensation PA-LIBC364-WC
• Defendant's Answer to Claim Petition under Pennsylvania Workers' Compensation Act PA-LIBC374-WC
• Answer to Petition for Workers' Compensation PA-LIBC377-WC

Workers Compensation - Benefit Offsets

• Notice of Workers' Compensation Benefit Offset for Workers' Compensation PA-LIBC761-WC

Workers Compensation - Claims

• Claim Petition for Workers' Compensation for Workers' Compensation PA-LIBC362-WC
• General Petition for Workers' Compensation PA-LIBC378-WC
• Checklists - Worker's Compensation Claims US-04076BG

Workers Compensation - Commutation

• Commutation of Compensation for Workers' Compensation PA-LIBC498-WC
• Answer to Petition for Commutation for Workers' Compensation PA-LIBC35-WC

Workers Compensation - Conferences

• Informal Conference Agreement Form for Workers' Compensation PA-LIBC754-WC
• Notice of Request Informal Conference for Workers' Compensation PA-LIBC753-WC

Workers Compensation - Death Claims

• Agreement for Compensation Death for Workers' Compensation PA-LIBC338-WC
• Supplemental Agreement for Compensation Death for Workers' Compensation PA-LIBC339-WC

Workers Compensation - Disability

• Supplemental Agreement for Compensation for Disability or Permanent Injury for Workers' Compensation PA-LIBC337-WC
• Notice of Change on Disability Status for Workers' Compensation PA-LIBC764-WC
• Agreement for Compensation for Disability or Permanent Injury - Workers' Compensation PA-LIBC336-WC

Workers Compensation - Discovery

• Claimant's First Set of Interrogatories to Employer and Carrier US-01365
• Claimant's First Set of Requests for Production US-01366
• Requests for Production of Documents to Carrier US-01367

Workers Compensation - Injury and Claims

• Notice of Work-Related Injury and Claim for Worker's Compensation US-01495BG

Workers Compensation - Injury Funds

• Claim Petition for Additional Compensation from the Subsequent Injury Fund PA-LIBC375-WC

Workers Compensation - Injury Reports

• Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State US-01494BG

Workers Compensation - Insurance

• Agreement of Employee Service Provider to Maintain Workers Compensation Insurance US-01625BG

Workers Compensation - Joinder

• Petition for Joinder of Additional Defendant for Workers' Compensation PA-LIBC376-WC

Workers Compensation - Medical Examinations

• Petition for Physical Examination for Workers' Compensation PA-LIBC499-WC

Workers Compensation - Modifications

• Notification of Suspension or Modification Pursuant to Ss413(C) and (D) - Workers' Compensation PA-LIBC751-WC

Workers Compensation - Notices

• Notice of Compensation Payable for Workers' Compensation PA-LIBC495-WC
• Notice of Ability to Return to Work for Workers' Compensation PA-LIBC757-WC

Workers Compensation - Payments

• Agreement to Stop Weekly Workers' Compensation Payments - Final Receipt PA-LIBC340-WC

Workers Compensation - Physicians

• Physician Affidavit of Recovery for Workers' Compensation PA-LIBC497-WC

Workers Compensation - Questionnaires

• Workers Compensation Questionnaire US-Q1038

Workers Compensation - Ratings

• Impairment Rating Evaluation Appointment for Workers' Compensation PA-LIBC765-WC
• Request for Physician to Perform Impairment Rating for Workers' Compensation PA-LIBC766-WC
• Impairment Rating Determination Face Sheet - Workers' Compensation PA-LIBC767-WC

Workers Compensation - Reinstatement

• Notice of Reinstatement for Workers' Compensation PA-LIBC763-WC

Workers Compensation - Releases

• Compromise and Release Agreement by Stipulation Pursuant to Section 449 of Workers' Compensation Act PA-LIBC755-WC

Workers Compensation - Reports

• Employee Report of Benefits for Workers' Compensation PA-LIBC756-WC
• Employee Report of Wages and Physical Condition for Workers' Compensation PA-LIBC750-WC

Workers Compensation - Reviews

• Utilization Review Request PA-LIBC601-WC
• Petition for Review or Utilization Review Determination for Workers' Compensation for Workers' Compensation PA-LIBC603-WC

Workers Compensation - Settlements

• Third Party Settlement Agreement for Workers' Compensation PA-LIBC380-WC

Workers Compensation - Statements

• Statement of Account of Compensation Paid - For All Workers' Compensation and Occupational Disease cases including fatalities for Workers' Compensation PA-LIBC392-WC

Workers Compensation - Suspensions

• Notice of Suspension for Failure to Return Form LIBC-760 for Workers' Compensation PA-LIBC762-WC

Workers Compensation - Temporary

• Notice Stopping Temporary Compensation for Workers' Compensation PA-LIBC502-WC
• Notice of Temporary Compensation Payable for Workers' Compensation PA-LIBC501-WC

Workers Compensation - Verifications

• Employee Verification of Employment, Self-Employment or Change in Physical Condition for Workers' Compensation PA-LIBC760-WC

Workers Compensation - Wages

• Statement of Wages - for Injuries Occurring On and After June 24, 1996 for Workers' Compensation PA-LIBC494C-WC
• Statement of Wages - for Injuries Occurring On or Before June 23, 1996 for Workers' Compensation PA-LIBC494A-WC