Our office is frequently contacted regarding questions related to forms that have been received by our clients asking questions about whether they have returned to work, or are receiving other benefits such as unemployment compensation or Social Security payments. Insurance carriers are permitted to send these forms once every six months to individuals who are either pursuing a claim for or are already receiving workers compensation benefits.
We are often asked whether these forms have to be filled out and returned to the insurance carrier, and what information should be put on the forms. The following is a short discussion of the forms that someone receiving workers compensation benefits may receive, and some tips regarding the proper way to deal with these forms.
There are three forms that can be sent by the insurance carrier that an employee is required to complete and return. These are as follows:
- LIBC – 750 –”Employee Report of Wages (Other Than Workers Compensation Benefits Received)”. This form requires an employee to report whether they have been employed or self-employed at any time while receiving workers compensation benefits. If so, information related to the dates of employment or self-employment, the name and address of the employer, and the amount of wages earned must be reported.
- LIBC – 756 –”Employee’s Report of Benefits (Unemployment Compensation, Social Security (Old Age), Severance and Pension Benefits) for Offsets“. This form requires the employee to report the receipt of any of these benefits and the amounts received. One of the biggest problems that we see with these forms occurs with the reporting of Social Security benefits that have been received. The form only requires the reporting of what are referred to on the form as “old age” benefits, not disability benefits. Social Security disability benefits do not need to be reported, and if an employee does so, their worker’s compensation payments may be reduced inappropriately. Further, special care should be taken if the age-based social security benefits were being received prior to the work injury. If the employee is receiving Social Security benefits prior to the injury occurring, no offset is permitted against the workers compensation payments.
- LIBC – 760 – “Employee Verification of Employment, Self-Employment or Change in Physical Condition“. In many ways, this form is similar to the LIBC – 750 form. However, even though the same information is being requested twice, it is important that the employee complete and return this form also.
The consequences of not returning the forms are significant. If the employee does not return the forms within thirty days, the workers compensation insurance carrier has the right to stop workers compensation payments until such time as the forms are completed and returned.
The workers compensation insurance carrier is required, when doing so, to resend the forms to the employee and to provide them with a notice stating that the benefits are being stopped because the forms have not been returned. The insurance carrier is not obligated to reinstate workers compensation benefits until the forms are returned, and is not required to make payment of the benefits between the time that they were stopped and the time that they have been reinstated.
Employees must also be very careful, when completing these forms, to be sure to complete both sides of the form, and most importantly to sign and date the form. The Commonwealth Court of Pennsylvania has specifically ruled that an employee’s failure to date the form makes it incomplete, entitling the workers compensation insurance carrier to stop payment of benefits.
If you are receiving workers compensation benefits and you receive these forms, it is important that you handle these correctly. Our office can assist in that regard, and if you find yourself having to deal with these forms and have questions, please fill free to call us.