Notice to the Claimant, LIBC-758

The Department of Labor & Industry, Bureau of Workers' Compensation, has made the following revision to the LIBC-758:

• This form has been renamed “Notice to Employee”

After June 6, 2011, prior versions of this form will not be accepted by the bureau and will be returned to you. An electronic version of the revised “Notice to Employee” and reproduction instructions are available online. Please note that this is a non-OCR form and does not need to be tested and approved by the bureau for formatting prior to use.