Agreement For Compensation For Disability Or Permanent Injury {LIBC-336} | Pdf Fpdf Docx | Pennsylvania

 Pennsylvania   Workers Comp 
Agreement For Compensation For Disability Or Permanent Injury {LIBC-336} | Pdf Fpdf Docx | Pennsylvania

Last updated: 4/3/2024

Agreement For Compensation For Disability Or Permanent Injury {LIBC-336}

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Description

LIBC-336 -- AGREEMENT FOR COMPENSATION FOR DISABILITY OR PERMANENT INJURY. This form is used by the Pennsylvania Department of Labor & Industry, Bureau of Workers' Compensation to formalize an agreement between an employee and their employer regarding compensation for disability or permanent injury resulting from a work-related incident. The form includes detailed information about the employee, employer, injury details, insurer or third-party administrator information, compensation details, and signatures from both the employee and the employer or insurer representative. www.FormsWorkflow.com

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