NOTICE OF WORKERS’ COMPENSATION DENIAL - EDI SUBMISSION ONLY Forms
| Form Name | NOTICE OF WORKERS’ COMPENSATION DENIAL - EDI SUBMISSION ONLY |
| Form # | LIBC-496 |
| Form Revision | REV 04-18 |
| Category | Forms » Board/Commission/Division |
| Downloads | |
| Form State | Pennsylvania |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |