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 89 State Forms found

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PETITION FOR PHYSICAL EXAMINATION OR EXPERT INTERVIEW OF EMPLOYEE (SECTION 314)

 LIBC-499 REV 04-18

STATEMENT OF WAGES (FOR INJURIES OCCURRING ON OR AFTER JUNE 24, 1996) - EDI

 LIBC-494C REV 05-22

STATEMENT OF WAGES (FOR INJURIES OCCURRING ON OR BEFORE JUNE 23, 1996)

 LIBC-494A REV 05-22

SUBPOENA

 LIBC-480 REV 08-10

SUPPLEMENTAL AGREEMENT FOR COMPENSATION FOR DISABILITY OR PERMANENT INJURY - EDI

 LIBC-337 REV 03-24

SUPPLEMENTAL AGREEMENT FOR COMPENSATION FOR DEATH

 LIBC-339 REV 03-24

THIRD PARTY SETTLEMENT AGREEMENT

 LIBC-380 REV 02-24

AGREEMENT FOR COMPENSATION FOR DISABILITY OR PERMANENT INJURY - EDI

 LIBC-336 REV 03-24

AGREEMENT TO STOP WEEKLY WORKERS’ COMPENSATION PAYMENTS FINAL RECEIPT - EDI

 LIBC-340 REV 03-24

PETITION FOR COMMUTATION

 LIBC-34 REV 04-18

ANSWER TO PETITION FOR COMMUTATION

 LIBC-35 04-18

IMPORTANT INFORMATION ABOUT THE PETITION FILING AND HEARING PROCESS

 LIBC-387 REV 04-18

DEFENDANT'S ANSWER TO OCCUPATIONAL DISEASE CLAIM PETITION SECTION 301(i) ONLY

 LIBC-524 REV 04-18

NOTICE OF ABILITY TO RETURN TO WORK - EDI

 LIBC-757 REV 04-18

NOTICE TO EMPLOYEE

 LIBC-758 REV 02-11
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