|
 Pennsylvania
Worker's Compensation
Automated
Forms Package includes everything you need:
LIBC-9
Medical
Report Form
LIBC-10
Authorization for Alternative Delivery of Compensation Payments
LIBC-25/26
Appeal
from Judge's Findings of Fact and Conclusions of Law
LIBC-34
Petition
for Commutation of Compensation
LIBC-35
Answer
to Petition for Commutation
LIBC-336
Agreement
for Compensation
LIBC-337
Supplemental
Agreement for Compensation
LIBC-338
Agreement
for Compensation for Death
LIBC-339
Supplemental
Agreement
LIBC-340
Agreement
to Stop Weekly Worker's Compensation Payments
LIBC-344
Employer's
Report of Occupational Injury or Disease
LIBC-362
Claim
Petition for Worker's Compensation
LIBC-363
Fatal
Claim Petition
LIBC-364B
Defendant's
Answer to Claim Petition Under PA Occupational Disease Act
LIBC-374
Defendant's
Answer to Claim Petition Under PA Worker's Compensation Act
LIBC-375
Claim
Petition for Additional Compensation from the Subsequent Injury Fund
LIBC-376
Petition
for Joinder
LIBC-377
Answer
to Petition To
LIBC-378
Petition
To
LIBC-380
Third
Party Settlement Agreement
LIBC-384
Fatal
Claim Petition for Compensation by Dependents for Death Covered by
the PA Occupational Disease Act
LIBC-386
Fatal
Claim Petition for Compensation by Dependents for Death Resulting
from Occupational Disease
LIBC-392
Statement
of Account of Compensation Paid
LIBC-396
Occupational
Disease Claim Petition
LIBC-480
Subpoena
1 / Subpoena 2
LIBC-494A
Statement
of Wages (for injuries occurring on or before June 23, 1996)
LIBC-494C
Statement
of Wages (for injuries occurring on and after June 24, 1996)
LIBC-495
Notice
of Compensation Payable
LIBC-496
Notice of
Worker's Compensation Denial
LIBC-497
Physician's
Affidavit
LIBC-498
Commutation
of Compensation
LIBC-499
Petition
for Physical Exam
LIBC-500
Employer/Insurance Company Information
LIBC-501
Notice
of Temporary Compensation Payable
LIBC-502
Notice
Stopping Temporary Compensation
LIBC-601
Utilization
Review Request
LIBC-603
Petition
for Review
LIBC-662
Application
for Supersedeas Fund Reimbursement
LIBC-686
Petition
for Penalties
LIBC-750
Employee
Report of Wages
LIBC-751
Notification
of Suspension
LIBC-753
Notice
of Request for Informal Conference
LIBC-754
Informal
Conference Agreement
LIBC-755
Compromise
and Release Agreement
LIBC-756
Employee's
Report of Benefits
LIBC-757
Notice
of Ability to Return to Work
LIBC-760
Employee
Verification
LIBC-761
Notice
of Worker's Compensation Benefit Offset
LIBC-762
Notice
of Suspension
LIBC-763
Notice
of Reinstatement
LIBC-764
Notice
of Change of Worker's Compensation Disability Status
LIBC-765
Impairment
Rating Evaluation Appointment
LIBC-766
Request
for Designation of a Physician to Perform an Impairment Rating
Evaluation
LIBC-767
Impairment
Rating Evaluation Appointment
Our
software development team is continually working to improve and
enhance our automated forms packages. If you are aware of a form
that would make a positive addition to the above list, we'd love to
hear about it! Please call us toll-free or email
the information.
For
immediate answers to your questions or to expedite an order, please
call us toll-free 1-800-556-7526, extension 1007 or send us an
email.
Pricing can be found on our secure
ShopSite by clicking on the blue "Order Now" button. Promotions are
currently running -- call the toll-free number above for details. | 
