Welcome to the Workers' Compensation Petition To/For: Web Application. This application allows you to file a Petition To/For: form via the Internet.
The instructions provided on the next page contain valuable information that, if read thoroughly, will lead to successful electronic submission of the Petition To/For: form. Navigation throughout the application should be done by clicking the provided buttons ONLY.
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Petition To Terminate Compensation
-- Important Notice --
A Form LIBC-378, "Petition To/For:," which seeks to "Terminate compensation: Based upon physician's affidavit, a special supersedeas hearing to be scheduled" as provided for in Section 413(a.1) of the Workers' Compensation Act, cannot be filed via the Bureau of Workers' Compensation (bureau) Web site. Forms requesting this relief must be filed with the bureau in paper form only.
When filing the paper form to request this relief, the blocks before and after the third choice of the "Petition To/For:" form must be checked in order to substantiate the request for a special supersedeas hearing to be scheduled, as follows:
Terminate Compensation: Based upon physician's affidavit, a special supersedeas hearing to be scheduled
In addition, the paper form requesting this relief must be accompanied by the completed Form LIBC-497, "Physician's Affidavit of Recovery." The bureau cannot match LIBC-497 forms that are submitted separately. Moreover, the LIBC-497 should only be filed with the bureau in conjunction with and attached to the LIBC-378 where the above relief is requested. Improperly filed LIBC-497 forms will not be kept as part of the bureau file.