US Legal Forms
Pennsylvania Statement of Wages (For Injuries Occurring On And After...

Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996)

Name: Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996)
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.67 (295 reviews)

Category:

Pennsylvania Workers Compensation - Official

State:

Pennsylvania

Control #:

PA-SKU-4659

Format:

Instant download

This website is not affiliated with any governmental entity

Public form

Description

Statement of Wages (For Injuries Occurring On And After June 24 1996) The Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24, 1996) is a document used in the state of Pennsylvania to report wages and other income earned by a worker who has been injured on the job. It is typically completed by the injured worker's employer and is used to determine the worker's compensation benefits. This document is also used to report income earned by a worker who has been injured off the job, provided the injury is related to the worker's employment. There are two types of this statement: the “Long Form” and the “Short Form.” The Long Form must be used when a worker has more than one employer, while the Short Form can be used when a worker has only one employer. The Long Form must also be used when the worker has any income from outside sources, such as investments or rental income, while the Short Form can be used when the worker has no other sources of income. Both forms must be signed and dated by the employer and must be submitted to the Pennsylvania Department of Labor and Industry in order to receive worker's compensation benefits.

The Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24, 1996) is a document used in the state of Pennsylvania to report wages and other income earned by a worker who has been injured on the job. It is typically completed by the injured worker's employer and is used to determine the worker's compensation benefits. This document is also used to report income earned by a worker who has been injured off the job, provided the injury is related to the worker's employment. There are two types of this statement: the “Long Form” and the “Short Form.” The Long Form must be used when a worker has more than one employer, while the Short Form can be used when a worker has only one employer. The Long Form must also be used when the worker has any income from outside sources, such as investments or rental income, while the Short Form can be used when the worker has no other sources of income. Both forms must be signed and dated by the employer and must be submitted to the Pennsylvania Department of Labor and Industry in order to receive worker's compensation benefits.

View Assignment of Lease and Rent from Borrower to Lender

View this form

View Partial Checklist for Filing Notice of Appeal

View this form

View Appendix A - Information Regarding Support Issues

View this form

View Case Management Checklist

View this form

View Domestic Relations Order regarding Property Settlement

View this form

How to fill out Pennsylvania Statement Of Wages (For Injuries Occurring On And After June 24 1996)?

Working with legal paperwork requires attention, precision, and using properly-drafted blanks. US Legal Forms has been helping people across the country do just that for 25 years, so when you pick your Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996) template from our library, you can be sure it complies with federal and state laws.

Dealing with our service is straightforward and fast. To obtain the necessary paperwork, all you’ll need is an account with a valid subscription. Here’s a brief guideline for you to find your Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996) within minutes:

Remember to attentively examine the form content and its correspondence with general and law requirements by previewing it or reading its description.
Look for an alternative formal template if the previously opened one doesn’t match your situation or state regulations (the tab for that is on the top page corner).
Log in to your account and download the Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996) in the format you need. If it’s your first experience with our service, click Buy now to continue.
Register for an account, choose your subscription plan, and pay with your credit card or PayPal account.
Choose in what format you want to save your form and click Download. Print the blank or upload it to a professional PDF editor to submit it electronically.

All documents are drafted for multi-usage, like the Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996) you see on this page. If you need them one more time, you can fill them out without re-payment - just open the My Forms tab in your profile and complete your document whenever you need it. Try US Legal Forms and accomplish your business and personal paperwork quickly and in total legal compliance!

Form Rating

4.67

Satisfied(295)

Form popularity

FAQ

1994) (?Section 204(a) prohibits, as against public policy, an employer from agreeing with his employee to hold employer harmless for any future injury the employee may suffer.?) (emphasis changed).

Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

In Pennsylvania, you have 120 days to inform your employer that you have been injured at work. This is the first step in receiving workers' compensation benefits.

Sole proprietors. Employees not working within the regular course of the employer's business. Agricultural workers hired to do less than 30 days of work and who earn less than $1,200/year from one employer. Employees who request an exemption based on religious beliefs or executive status in certain corporations.

Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid.

In Pennsylvania, the 90-day rule states that injured workers must initially see "panel physicians??a list of pre-approved doctors posted by the employer?within 90 days of their workplace injury to receive compensation. If they see a different doctor, workers' compensation won't necessarily have to cover the cost.

An employee injury is to be reported to the employer within 21 days; if not reported within 120 days from the date of injury or having knowledge of a work-related disease, no compensation is allowed (except for cases involving progressive diseases).

More info

If the employee had more than one employer at the time of injury, a separate Statement of Wages form must be completed for each employer. (TOLL FREE) 800-482-2383.Reenacted and Amended June 21, 1939, P.L.520, No.281. View on Westlaw or start a FREE TRIAL today, § 12. Form of statement of wages for injuries occurring on and after June 24, 1996, Secondary Sources. For injuries occurring on or before June 23, 1996, the form LIBC-494A (Statement of Wages) must be completed. Documentation, maintenance of complete and accurate records of wages paid. -137. Prepare Statement of Wages with (a) accepting Instrument other than acceptance for "Medical Only" or, (b) following denial of. The UEF applies only to injuries occurring on or after July 1, 1996. What happens after I file the claim form?

Pennsylvania Statement of Wages (For Injuries Occurring On And After June 24 1996)

Description

Related forms

How to fill out Pennsylvania Statement Of Wages (For Injuries Occurring On And After June 24 1996)?

Show more info

Form Rating

Form popularity

FAQ

What is Section 204 of PA workers compensation Act?

What is the Pennsylvania Workers Compensation First Report of injury Form?

How long does an employee have to report an injury in PA?

What is exemption for workers compensation in PA?

Which type of document is filed with the workers compensation Board?

What is the EMPLOYERS report of occupational injury or illness form 5020?

What is the 90 day rule for workers comp in PA?

How long do you have to report workers comp injuries in PA?

More info

Trusted and secure by over 3 million people of the world’s leading companies