What is an Employee’s Report of Benefits/wages and Employee’s Verification of Employment and Do I Have to Fill This Out?

If you’ve received a form in the mail titled “Employee’s Report of Benefits” (LIBC-756), “Employee’s Report of Wages” (LIBC-750), or “Employee’s Verification of Employment, Self-Employment or Change in Physical Condition” (LIBC-760) you might be confused and suspicious.

The first thing you should know is that these are standard forms. Your employer or their Pennsylvania (PA) Workers’ Compensation Insurance company can send you these forms every six months. These forms are rather straight-forward and ask you to report any wages you’ve earned while collecting or seeking workers’ comp, ask if you have been employed or self-employed at any point while collecting or seeking compensation benefits, and ask if you’ve received any Social Security, pension, severance, or unemployment benefits during the period you have been collecting or seeking Pennsylvania WC benefits. If you are receiving Social Security Disability benefits do not report them as Social Security Old Age benefits as this will cause the carrier to take an imporper credit against your weekly compensation. These forms may also require the employee to report any change in physical condition that could affect his or her entitlement to TTD benefits. This is an easy way for the Insurance company to gather information about your case.

These forms require that you complete them and return them to your insurance company within thirty (30) days. Failure to complete these forms and return them within these 30 days allows the insurance company to file a Petition to Suspend your workman’s compensation wage loss benefits. The insurer can suspend your benefits until the proper forms are completed and submitted. Additionally, if an employee’s benefits are suspended due to a failure to timely return these forms and the employee later fills out and returns the forms, the employee’s benefits will start back up, but the employee will be unable to get retroactive benefits the portion of time that coincides with the suspension. This is another reason why it is very important to complete, sign, and send the forms back within the 30 day time period.

An injured worker must take care to ensure that the information being provided on these forms is complete and accurate. If a worker dealing with a work-related injury knowingly, with intent to defraud, fails to make the required reports or gives false or misleading information, he may be liable under the fraud provisions of the Workers’ Compensation Act.

It is very important that these forms are filled out on time and filled out accurately. For this reason, it is a good idea to consult with an experienced workers’ compensation attorney before trying to fill out a form that you might not understand. If you have any questions, we can answer them for free.