Workers’ Compensation Forms

Getting through the maze of workers’ compensation paperwork can be complicated. The last thing you need to do when you are trying to recover from a work injury is to spend your days trying to figure out what forms you need to fill out. However, with the help of an experienced workers’ compensation attorney, you don’t have to worry about all of these issues.

Important Workers’ Compensation Forms

As an injured worker, you can see the complete list of Pennsylvania workers’ compensation forms at the website of the PA Department of Labor and Industry.

As you can see, it is a long list. They address all kinds of issues from waiving workers’ compensation benefits based on religious beliefs to agreements for compensation when injury or death happens on the job.

Some of the different forms that you are going to need to sign and complete for every workers’ compensation claim include:

• Claim Petition for Workers’ Compensation – This form must include a complete description of your illness or injury. If your work injury claim is based on an occupational disease, you must prove the last date of employment and the last date of exposure. You also need to provide information on what you were doing and where you were working when the injury happened, and when your employer was notified.  The Petition must be completed as fully as possible and sent to the employer and Bureau of Workers’ Compensation.
• Authorization for Medical Records – You need to release your medical records to the workers’ compensation insurance company so that the records can be reviewed and your claim processed.
• Employee Verification Form – You need to complete this form when you apply for benefits as well as when a change in your physical condition occurs.  The form has to be completed within 30 days of the time when it is sent to you. It must be sent back to whomever sent it. If you don’t return it, you could jeopardize your ongoing benefits.

You should always read any forms carefully before signing. You should also make sure the forms are completed in full so your claim is not denied or delayed.

Don’t Sign Workers’ Compensation Forms Without a Lawyer

There are many workers’ compensation forms that you do not want to sign unless and until they have been reviewed by an attorney. Signing the forms could affect your benefits. It could even cause your benefits to stop. So, you have to be very careful.

For example, forms that could impact your benefits include:

• Supplemental Agreement for Compensation – If you sign this, you agree to go back to work even though your claim may still be open. Your benefits could be terminated. So, don’t sign this form unless you have fully recovered.
• Agreement to Stop (Final Receipt) – This form also stops your benefits.

Many workers’ compensation forms look alike. You may be pressured to sign forms without knowing exactly what they are or what impact they will have. Don’t take a chance and sign something before you have a lawyer review it first.

Our Lawyers Help with PA Workers’ Compensation Forms

At Shor & Levin, P.C., our workers’ compensation lawyers can complete the paperwork you need filed and include all required documentation. We can also review anything and everything your employer or the insurer is asking you to sign. To make sure you have a knowledgeable attorney looking after your rights, contact us without delay. You can find additional resources here.

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Forms and Printing Instructions, Pennsylvania Workers’ Compensation, Pennsylvania Department of Labor and Industry