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Workers' Compensation Petitions

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Click on any of the links below to find out more information on Workers' Compensation Petitions

LIBC-336: Agreement for Compensation for Disability or Permanent Injury

LIBC-337: Supplemental Agreement for Compensation for Disability or Permanent Injury

LIBC-344: Employer's Report of Occupational Injury or Disease

LIBC-362: Claim Petition for Workers' Compensation

LIBC-494C: Statement of Wages

LIBC-495: Notice of Compensation Payable

LIBC-496: Notice of Workers' Compensation Denial

LIBC-501: Notice of Temporary Compensation Payable

LIBC-502: Notice Stopping Temporary Compensation

LIBC-601: Utilization Review Request

LIBC-686: Petition for Penalties

LIBC-750: Employee Report of Wages and Physical Condition

LIBC-751: Notification of Suspension or Modification

LIBC-756: Employee's Report of Benefits for Offsets

LIBC-757: Notice of Ability to Return to Work

LIBC-760: Employee Verification of Employment, Self-Employment or Change in Physical Condition

LIBC-761: Notice of Workers' Compensation Benefit Offset

LIBC-762: Notice of Suspension for Failure to Return Form LIBC-760

LIBC-763: Notice of Reinstatement of Workers' Compensation Benefits

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