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Pennsylvania Supplemental information Addendum to Application as a Group Workers' Compensation Fund

State:
Pennsylvania
Control #:
PA-SKU-4556
Format:
PDF
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Supplemental information Addendum to Application as a Group Workers' Compensation Fund The Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund is a document required by the Pennsylvania Workers' Compensation Board for employers to complete when applying for a group workers' compensation fund. This addendum is used to provide additional information to the Board that is relevant to the employer's operations and workers' compensation eligibility. It includes a variety of information including the employer's organizational structure, details of the employer's safety program, and a list of all employees and their job descriptions. The addendum also includes a description of the employer's claims management system, a description of the employer's risk management strategy, and any additional information the employer would like to provide. There are two types of Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund: the Standard and the Expanded. The Standard Addendum is used when the employer is applying for a Basic Group workers' compensation fund, while the Expanded Addendum is used when the employer is applying for an Enhanced Group workers' compensation fund.

The Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund is a document required by the Pennsylvania Workers' Compensation Board for employers to complete when applying for a group workers' compensation fund. This addendum is used to provide additional information to the Board that is relevant to the employer's operations and workers' compensation eligibility. It includes a variety of information including the employer's organizational structure, details of the employer's safety program, and a list of all employees and their job descriptions. The addendum also includes a description of the employer's claims management system, a description of the employer's risk management strategy, and any additional information the employer would like to provide. There are two types of Pennsylvania Supplemental Information Addendum to Application as a Group Workers' Compensation Fund: the Standard and the Expanded. The Standard Addendum is used when the employer is applying for a Basic Group workers' compensation fund, while the Expanded Addendum is used when the employer is applying for an Enhanced Group workers' compensation fund.

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Pennsylvania Supplemental information Addendum to Application as a Group Workers' Compensation Fund