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 89 State Forms found

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CLAIM PETITION FOR WORKERS' COMPENSATION

 LIBC-362 REV 08-20

PHYSICIAN'S AFFIDAVIT OF RECOVERY

 LIBC-497 REV 04-18

AGREEMENT FOR COMPENSATION FOR DEATH - EDI

 LIBC-338 REV 03-24

ANSWER TO PETITION TO/FOR:

 LIBC-377 REV 04-18

APPLICATION FOR FEE REVIEW PURSUANT TO SECTION 306 (F.1)

 LIBC-507 REV 01-23

AUTHORIZATION FOR ALTERNATIVE DELIVERY OF COMPENSATION PAYMENTS

LIBC-10 REV 09-22

CLAIM PETITION FOR ADDITIONAL COMPENSATION FROM THE SUBSEQUENT INJURY FUND PURSUANT TO SECTION 306.1 OF THE WORKERS’ COMPENSATION ACT

 LIBC-375 REV 01-23

CLAIM PETITION FOR BENEFITS FROM THE UNINSURED EMPLOYER AND THE UNINSURED EMPLOYERS GUARANTY FUND

 LIBC-550 REV 04-18

COMMUTATION OF COMPENSATION - EDI

 LIBC-498 REV 06-22

COMPROMISE AND RELEASE AGREEMENT BY STIPULATION PURSUANT TO SECTION 449 OF THE WORKERS’ COMPENSATION ACT

 LIBC-755 REV 01-22

DEATH CLAIM SUPPLEMENT TO COMPROMISE AND RELEASE AGREEMENT

 LIBC-749 REV 02-11

DEFENDANT’S ANSWER TO CLAIM PETITION UNDER PENNSYLVANIA OCCUPATIONAL DISEASE ACT

 LIBC-364B REV 04-18

DEFENDANT’S ANSWER TO CLAIM PETITION UNDER PA WORKERS’ COMPENSATION ACT

 LIBC-374 REV 04-18

DISMEMBERMENT CHART SEC. 306(c) WORKERS’ COMPENSATION ACT AS AMENDED

 LIBC-134F REV 09-22

DISMEMBERMENT CHART SEC. 306(c) WORKERS’ COMPENSATION ACT AS AMENDED

 LIBC-134 REV 09-22
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