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LIBC-494c: Statement of Wages

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The Statement of Wages is a form that calculates the amount of compensation you will receive after a work injury or disease.

This form must be filed with either the Notice of Temporary Compensation Payable, Notice of Compensation Payable, or Agreement for Compensation for Disability or Permanent Injury. For it to be binding it must be filed with the Bureau of Workers' Compensation and a copy must be provided to you.

You should contact The Pisanchyn Law Firm's experienced Workers' Compensation attorneys once you receive this form to ensure it is filled out correctly and you will be receiving the right amount of compensation. It's very easy to get confused with all the petitions that can, and will, be filed throughout your claim. Call us now so we can get you the compensation you deserve.

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Are You Receiving the Correct Amount of Compensation?

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