The Agreement for Compensation for Disability or Permanent Injury (Agreement) is filed by the employer/insurer and is an agreement signed by both the employer/insurer and the claimant establishing the payment of compensation. This form is an alternative method to the Notice of Compensation Payable for the commencement of payments and contains somewhat more detailed information. The Agreement should be sent to the employee for signature and filed with the Bureau no later than 21 days from the date the employer had notice or knew of the disability. If the employer has not obtained the wages necessary to properly calculate the employee's compensation payable, the Agreement may be filed based upon the employee's estimated wages. If the estimated wages are not correct, the employer should file an amended Agreement. The form should be clearly identified as estimated or amended.

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