WC Forms Submission Reminders

If you have contracted a printing or software company, or intend to produce Bureau forms yourself, you or the contractor may be interested in obtaining form "files" from us. These files may be downloaded directly by you or your contractor. Extreme caution must be exercised when using these files as they do not reproduce exactly due to the many variations in software and hardware.
 
The files should only be used for language and layout (exact positioning may vary depending on the software and printer used). We suggest that you make a direct comparison with our hard copy forms prior to producing them in final form and submit samples, with sample data, to us for testing.

  • All two-sided forms (duplex) should be submitted as a single sheet, duplex form.
     
  • Use a medium point black ink pen on all forms or have them typed.
     
  • Do not use colored paper.
     
  • List the appropriate county on the forms when requested.
     
  • Please double-check the accuracy of the information provided, such as employee name, address and social security number, employer name and address, insurance information, injury date and description of injury.
     
  • Employee signature on the Notice of Suspension or Modification form (Form LIBC-751) is required only if employee is intending to create an Employee Challenge and request a special hearing regarding the suspension or modification. Employee signature should appear when the Employee Challenge box is checked.
     
  • Bureau codes are critical to assignment of the claim to the correct insurer and employer address. Bureau codes are four-digit numbers that identify the insurer or self-insured employer for notifications as necessary.
     
  • Signatures on forms are required on some forms. This is a mandatory requirement if requested on the form.

First Report of Injury (FROI)

Effective January 1, 2006, all submissions are required to be submitted electronically. The LIBC-344 is deleted. Be sure to use the NAICS code, critical to the Bureau in conducting statistical analysis of injuries by industry type.
 
Do not transmit a web application or Electronic Data interchange (EDI) file unless the injured party has missed a full shift of work (less than one full shift is considered no lost time by law and is not processed by the Bureau).

Answers to Petitions

We encourage you to submit the answers to petitions directly to the workers' compensation judge assigned to the case.

Supplemental Agreement for Compensation for Disability or Permanent Injury

If you are using a single Supplemental Agreement to report multiple periods, list the most recent period of payment on the front of the form and subsequent periods of payment under "other matters agreed upon" on the reverse of the form.

Insurance Carriers and Third-Party Administrators, please note

The PA BWC Claim Number is the number the Bureau assigns to a case and is NOT your claim number. Only indicate your claim number on forms where we request the "carrier’s claim number." Please take care to complete all forms within the space provided. Information improperly placed within a field will scan incorrectly and delay processing.
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