Supplemental Agreement for Compensation for Disability or
Permanent Injury, LIBC-337

The Department of Labor & Industry, Bureau of Workers' Compensation, has revised the Supplemental Agreement for Compensation for Disability or Permanent Injury, form LIBC-337, by making the following changes: the contact information and fraud language were updated; the duplicate request for the weekly earnings was removed; the further matters section was expanded to incorporate the multiple period information; and an EEO disclosure was added.
 
After February 21, 2011, prior versions of the form will not be accepted by the bureau and will be returned to you.
 
An electronic version of the revised Supplemental Agreement for Compensation for Disability or Permanent Injury and reproduction instructions to be used by your printing contractor are available online.
 
Please note that all bureau forms must be tested and approved by the bureau for formatting prior to use.
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