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 25 State Forms found

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PHYSICIAN'S AFFIDAVIT OF RECOVERY

 LIBC-497 REV 04-18

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

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

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

EMPLOYEE’S AFFIDAVIT AND WAIVER OF WORKERS’ COMPENSATION BENEFITS AND STATEMENT OF RELIGIOUS SECT

 LIBC-14B REV 01-24

EMPLOYEE VERIFICATION OF EMPLOYMENT, SELF-EMPLOYMENT OR CHANGE IN PHYSICAL CONDITION

 LIBC-760 REV 06-22

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

PETITION FOR JOINDER OF ADDITIONAL DEFENDANT

 LIBC-376 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
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