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 89 State Forms found

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NOTICE OF REQUEST FOR AN INFORMAL CONFERENCE

 LIBC-753 REV 04-18

NOTIFICATION Of SUSPENSION OR MODIFICATION - EDI

 LIBC-751 REV 01-23

NOTICE OF SUSPENSION FOR FAILURE TO RETURN FORM LIBC-760 - EDI

 LIBC-762 REV 06-22

NOTICE OF TEMPORARY COMPENSATION PAYABLE - EDI SUBMISSION ONLY

 LIBC-501 REV 04-18

NOTICE OF WORKERS’ COMPENSATION BENEFIT OFFSET - EDI

 LIBC-761 REV 06-22

NOTICE OF WORKERS’ COMPENSATION DENIAL - EDI SUBMISSION ONLY

 LIBC-496 REV 04-18

NOTICE STOPPING TEMPORARY COMPENSATION - EDI SUBMISSION ONLY

 LIBC-502 REV 04-18

NOTICE: MEDICAL TREATMENT FOR YOUR WORK INJURY OR OCCUPATIONAL ILLNESS

 No Form Number No Form/Rev Date

OCCUPATIONAL DISEASE CLAIM PETITION MONTHLY COMPENSATION FOR DISABILITY UNDER SECTION 301(i) ONLY

 LIBC-396 REV 01-23

PENNSYLVANIA WORKERS' COMPENSATION & WORKPLACE SAFETY 2017 ANNUAL REPORT

 LIBC-772 REV 05-18

PETITION FOR JOINDER OF ADDITIONAL DEFENDANT

 LIBC-376 REV 04-18

PETITION FOR REVIEW OF UTILIZATION REVIEW DETERMINATION

 LIBC-603 REV 04-18

PETITION TO/FOR: (Check any that apply)

 LIBC-378 REV 08-20

REQUEST FOR HEARING TO CONTEST FEE REVIEW DETERMINATION

 LIBC-606 REV 06-21

SECTION 304.2 APPLICATION FOR RELIGIOUS EXCEPTION OF SPECIFIED EMPLOYEES FROM THE PROVISIONS OF THE PENNSYLVANIA WORKERS’ COMPENSATION ACT

 LIBC-14A REV 01-24
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