Pennsylvania Workers’ Compensation Legal Forms
Helping Injured Workers Through the Complex Process of Claiming Benefits
If you have sustained an injury while in the court of your job duties, the Pennsylvania Workers’ Compensation Act allows you to collect benefits while you recover. There is a tremendous amount of paperwork and documentation that goes into making a successful claim for benefits, which is why you should always work with an experienced workers’ compensation attorney when you file your claim or seek an appeal.
Below you will find links to some of the more common documentation for making a claim. If you are self-insured, there are additional materials and steps you will take, and you should contact our firm immediately to find out what your rights are.
If you wish to file a claim for workers’ compensation in Pennsylvania, the Department of Labor & Industry recommends you read the following information:
Common Legal Forms Used in Claims for Workers’ Compensation in Pennsylvania
All titles and links come directly from the Pennsylvania Department of Labor & Industry. Some links are for informational purposes only, and cannot be printed and filled out.
LIBC 9 Medical Report Form
LIBC 34 Petition for Commutation
LIBC 338 Agreement for Compensation for Death
LIBC 377 Answer to Petition To/For
LIBC 380 Third Party Settlement Agreement
LIBC 480 Subpoena
LIBC 495 Notice of Compensation Payable
LIBC 497 Physician’s Affidavit of Recovery
LIBC 499 Petition for Physical Examination or Expert Interview of Employee (Section 314)
LIBC 504 Child Support Lien Affidavit
LIBC 750 Employee Report of Wages
LIBC 754 Informal Conference Agreement Form
LIBC 757 Notice of Ability To Return To Work
Hurt at Work? Let Us Help You
Larry Pitt & Associates is the Philadelphia workers’ compensation law firm you can trust. We’ve been helping your friends and neighbors recover after a worksite injury for close to 40 years. If you or your family member was hurt on the job, we will fight on your behalf. To schedule your free consultation with one of our Philadelphia workers’ compensation attorneys, please call 1-888-PITT-LAW or fill out our contact form. We proudly represent clients in Bucks County, Berks County, Chester County, Delaware County, Montgomery County and Philadelphia County.