| Title |
Last Updated |
| Agreement For Compensation For Disability Or Permanent Injury |
July 10, 2019 |
| Third Party Settlement Agreement |
November 7, 2018 |
| Executive Officers Declaration |
June 15, 2018 |
| Employee Verification Of Employment Self-Employment Or Change In Physical Condition |
June 14, 2018 |
| Employee Report Of Wages And Physical Condition |
June 14, 2018 |
| Dismemberment Chart (Hand) |
June 14, 2018 |
| Dismemberment Chart (Foot) |
June 14, 2018 |
| Defendants Answer To Occupational Disease Claim Petition Section 301(i) Only |
June 14, 2018 |
| Defendants Answer To Claim Petition Under Pennsylvania Workers Compensation Act |
June 14, 2018 |
| Defendants Answer To Claim Petition Under Pennsylvania Occupational Disease Act |
June 14, 2018 |
| Compromise And Release Agreement |
June 14, 2018 |
| Commutation Of Compensation |
June 14, 2018 |
| Claim Petition For Workers Compensation |
June 14, 2018 |
| Claim Petition For Benefits From Uninsured Employer Guaranty Fund And Uninsured Employer |
June 14, 2018 |
| Claim Petition For Additional Compensation From Subsecquent Injury Fund |
June 14, 2018 |
| Authorization For Alternative Delivery Of Compensation Payments |
June 14, 2018 |
| Workers Compensation Medical Report Form |
June 14, 2018 |
| Utilization Review Determination Face Sheet |
June 14, 2018 |
| Supplemental Information Addendum To Group Workers Compensation Fund |
June 14, 2018 |
| Supplemental Information Addendum To Group Sel-Insurance Fund Annual Report |
June 14, 2018 |
| Supplemental Information Addendum To Application As A Group Workers Compensation Fund |
June 14, 2018 |
| Supplemental Information Addendum To Annual Report Of Runoff Group Self-Insurance Fund |
June 14, 2018 |
| Supplemental Agreement Form Compensation For Death |
June 14, 2018 |
| Statement Of Wages (For Injuries Occurring On Or Before June 23 1996) |
June 14, 2018 |
| Request For Hearing To Contest Fee Review Determination |
June 14, 2018 |
| Physicians Affidavit Of Recovery |
June 14, 2018 |
| Petition To |
June 14, 2018 |
| Petition For Review Of Utilization Review Determination |
June 14, 2018 |
| Petition For Physical Examination Or Expert Interview Of Employee (Section 314) |
June 14, 2018 |
| Petition For Joinder Of Additional Defendant |
June 14, 2018 |
| Occupational Disease Claim Petition |
June 14, 2018 |
| Notification Of Suspension Or Modification Pursuant To Section 413 (C) And (D) |
June 14, 2018 |
| Notice Of Suspension For Failure To Return Form LIBC-760 |
June 14, 2018 |
| Notice Of Request For An Informal Conference |
June 14, 2018 |
| Notice Of Reinstatement Of Workers Compensation Benefits |
June 14, 2018 |
| Notice Of AbilityTo Return To Work |
June 14, 2018 |
| Informal Conference Agreement Form |
June 14, 2018 |
| Final Statement Of Account Of Compensation Paid |
June 14, 2018 |
| Fatal Claim Petition For Compensation By Dependents Of Deceased Employees |
June 14, 2018 |
| Employees Report Of Benefits |
June 14, 2018 |
| Application For Executive Officer Exception |
June 14, 2018 |
| Answer To Petition To |
June 14, 2018 |
| Agreement To Stop Weekly Workers Compensation Payments (Final Receipt) |
June 14, 2018 |
| Agreement For Compensation For Death |
June 14, 2018 |
| Utilization Review Request |
May 17, 2018 |
| Supplemental Agreement For Compensation For Disability Or Permanent Injury |
May 17, 2018 |
| Section 304.2 Application For Religious Exception Of Specified Employes |
May 17, 2018 |
| Petition For Commutation |
May 17, 2018 |
| Notice Of Claim Against Uninsured Employer |
May 17, 2018 |
| Employers Insurance Information Sheet |
May 17, 2018 |
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