- 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.
For More Information
Forms and Printing Instructions, Pennsylvania Workers’ Compensation, Pennsylvania Department of Labor and Industry