Authorization For Alternative Delivery Of Compensation Payments {LIBC-10}

LIBC-10 - AUTHORIZATION FOR ALTERNATIVE DELIVERY OF COMPENSATION PAYMENTS. This is a Pennsylvania Bureau of Workers’ Compensation form used by claimants to designate how they receive workers’ compensation payments. This form allows an injured employee to choose an alternative delivery method, such as picking up checks at the employer or insurer’s office, receiving payments by mail at a specified address, or selecting another approved option. It captures claimant, employer, and insurer details, along with claim identifiers and authorization signatures. The form also clarifies that claimants are not required to change delivery methods and that direct deposit requires a separate form (LIBC-215). www.FormsWorkflow.com