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Pennsylvania Supplemental information Addendum to Application as a Group Workers' Compensation Fund

State:
Pennsylvania
Control #:
PA-SKU-4556
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PDF
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Supplemental information Addendum to Application as a Group Workers' Compensation Fund
The Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund is a document required by the Pennsylvania Workers' Compensation Board for employers to complete when applying for a group workers' compensation fund. This addendum is used to provide additional information to the Board that is relevant to the employer's operations and workers' compensation eligibility. It includes a variety of information including the employer's organizational structure, details of the employer's safety program, and a list of all employees and their job descriptions. The addendum also includes a description of the employer's claims management system, a description of the employer's risk management strategy, and any additional information the employer would like to provide. There are two types of Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund: the Standard and the Expanded. The Standard Addendum is used when the employer is applying for a Basic Group workers' compensation fund, while the Expanded Addendum is used when the employer is applying for an Enhanced Group workers' compensation fund.

The Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund is a document required by the Pennsylvania Workers' Compensation Board for employers to complete when applying for a group workers' compensation fund. This addendum is used to provide additional information to the Board that is relevant to the employer's operations and workers' compensation eligibility. It includes a variety of information including the employer's organizational structure, details of the employer's safety program, and a list of all employees and their job descriptions. The addendum also includes a description of the employer's claims management system, a description of the employer's risk management strategy, and any additional information the employer would like to provide. There are two types of Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund: the Standard and the Expanded. The Standard Addendum is used when the employer is applying for a Basic Group workers' compensation fund, while the Expanded Addendum is used when the employer is applying for an Enhanced Group workers' compensation fund.

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FAQ

Pennsylvania law requires all employees to be covered by workers' compensation, but independent contractors are not employees. There are laws specifying who can and cannot be considered an independent contractor, and many employees are misclassified as contractors.

Sole proprietors. Employees not working within the regular course of the employer's business. Agricultural workers hired to do less than 30 days of work and who earn less than $1,200/year from one employer. Employees who request an exemption based on religious beliefs or executive status in certain corporations.

In Pennsylvania, workers' compensation benefits are paid for by employers. Workers' compensation is an insurance product that covers most employees who are injured in a work-related accident.

Criminal Consequences Failing to carry workers' comp insurance is a criminal offense; a non-compliant employer in Pennsylvania can face fines up to $2500 and/or one year in prison for each day that the employer does not have coverage for employees.

Workers' compensation coverage is mandatory for most employers under Pennsylvania law. Employers who do not have workers' compensation coverage may be subject to lawsuits by employees and to criminal prosecution by the commonwealth.

Is there a waiting period in Pennsylvania? In the State of Pennsylvania there is a 7 day waiting period. An employee must be off work a total of 14 days to be paid for the first 7 days of disability.

Section 413 allows a workers' compensation carrier to suspend or modify a Claimant's wage loss benefits when the employee has returned to work at prior or increased earnings.

The Coming and Going Rule. Employees in Pennsylvania often inquire about whether workers' compensation benefits are payable if they are injured while on the way to or from work. In general, employees injured while commuting to or from work will not be eligible for workers' compensation benefits.

More info

TDI Form NumberDescriptionFile FormatLanguageDWC003Employer's wage statement. Rev. Providers for group practice enrollment. •.Refer to Addendum 3 to add additional license and certification information. Attach documentation as needed. For additional information, see the Online Public Meeting Notice. The Alaska Workers' Compensation Board will conduct a full board meeting on May 18-19, 2023. These benefits are the responsibility of the self-insured employer or the employer's worker's compensation insurance carrier. Benefits include medical treatment for work-related conditions and cash payments that partially replace lost wages. STEP 1: Complete an Application. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes

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Pennsylvania Supplemental information Addendum to Application as a Group Workers' Compensation Fund