The Pennsylvania Statement of Wages (For Injuries Occurring On Or Before June 23, 1996) is a form issued by the Pennsylvania Department of Labor and Industry that is used to report the wages of employees who have been injured on the job. It is used to determine the amount of compensation to be paid out to an injured worker. The form includes information such as the employee’s name, address, date of injury, wage rate, total wages earned, and any deductions taken. There are three types of Pennsylvania Statement of Wages (For Injuries Occurring On Or Before June 23, 1996): Form LIBC-717, Form LIBC-717A, and Form LIBC-717B. Form LIBC-717 is used to report the wages of employees who have been injured on or before June 23, 1996. Form LIBC-717A is used to report the wages of employees who have been injured after June 23, 1996. Form LIBC-717B is used to report the wages of employees who have been injured after June 23, 1996, and who are currently receiving workers’ compensation payments.
Pennsylvania Statement of Wages (For Injuries Occurring On Or Before June 23 1996)
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SECTION 306 (f.1)(1)(i) The employer shall provide payment in ance with this section for reasonable surgical and medical services, services rendered by physicians or other health care providers, including an additional opinion when invasive surgery may be necessary, medicines and supplies, as and when needed.
The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested.
The Pennsylvania Workers' Compensation Act provides wage loss and medical benefits to compensate employees suffering from work- related injuries or diseases. The Act also provides for death benefits to the dependents of workers who die as a result of a work-related injury or disease.
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.
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.
If the insurance company or employer accepts your claim, then you can expect workers' compensation checks within roughly 28 days of your date of injury.
Section 305(d) provides: ?when any employer fails to secure the payment of compensation under this act as provided in sections 305 and 305.2, the injured employee or his dependents may proceed either under this act, or in a suit for damages at law as provided by Article II.?
How to File a Workers' Compensation Claim in PA Inform Your Employer of Your Injury.Seek Immediate Medical Attention.File Your Claim With the Pennsylvania Department of Labor and Industry.Fill Out All the Required Workers' Compensation Claim Forms.