Beginning February 20, 2022, a revised bureau form (LIBC 751) must be used when suspending or modifying a claimant’s workers’ compensation benefits. The revision was necessary to comply with Act 95, which Governor Wolf signed into law on December 22, 2021.
Unlike the previous form, the revised form contains two verification boxes that must be checked before the document is signed. The insurer must verify or confirm that a copy of the form was served to both the Bureau of Workers’ Compensation and to the employee. You may submit the form via WCAIS to the Bureau and mail a copy to the claimant (and claimant’s attorney, if known.) The form must be filed with the Bureau and sent to claimant within seven days of the claimant’s return to work.
You may download a copy of the revised form here.