Spreadsheet: 4568d72f-2c82-410f-90c7-df635e042dc6
Sheet: Sheet1

WCOA Forms
Form (LIBC) Number | Form Name | Program Area | Format | WCAIS Usage | Print (P) | Interactive (I) | Submission Method | Form must be sent to Claimant / Injured Worker (Y or N) | Revised form must be used by this date
34 | Petition for Commutation | WCOA | Web/Fillable | Mail | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
112 | WC Hearing - Interested Party Update Request Instructions |  |  |  | P | N/A | N/A | N/A | N/A
113 | WC Hearing - Interested Party Update Request |  |  |  | P | I | Hand deliver to hearing | N/A | N/A
35 | Answer to Petition for Commutation |  |  |  | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
362 | Claim Petition for Workers' Compensation |  |  |  | P | I | WCAIS screens or mail | N/A | 2104-06-30 00:00:00
363 | Fatal Claim Petition for Compensation by Dependents of Deceased Employees | WCOA | Web/Fillable | Upload      Mail | P | I | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
364B | Defendant's Answer to Claim Petition Under Pennsylvania Occupational Disease Act | WCOA | Web/Fillable | Upload      Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
374 | Defendant's Answer to Claim Petition under Pennsylvania Workers' Compensation | WCOA | Web/Fillable | Upload/Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
375 | Claim Petition or Additional Compensation From the Subsequent Injury Fund Pursuant to Section 306.1 of the Workers' Compensation Act | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
376 | Petition for Joinder of Additional Defendant | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
377 | Answer to Petition To/For | WCOA | Web/Fillable | Upload/Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
378 | Petition TO/FOR: (Check any that apply) | WCOA | Web/Fillable | Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
384 | Fatal Claim Petition for Compensation by Dependents for Death Covered by the Pennsylvania Occupational Disease Act | WCOA | Web/Fillable | Upload | Please contact the BWC Helpline to obtain this form | Please contact the BWC Helpline to obtain this form | Please contact the BWC Helpline to obtain this form. | N/A | 2014-06-30 00:00:00
386 | Fatal Claim Petition for Compensation by Dependents For Death Resulting From Occupational Disease | WCOA | Web/Fillable | Upload/Mail | Please contact the BWC Helpline to obtain this form | Please contact the BWC Helpline to obtain this form | Please contact the BWC Helpline to obtain this form. | N/A | 2014-06-30 00:00:00
387 | Important Information About the Petition Filing and Hearing Process | WCOA | Web | N/A | P | N/A | N/A | N/A | N/A
396 | Occupational Disease Claim Petition Monthly Compensation for Disability Under Section 301(i) Only | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
480 | Subpoena |  |  |  | P | N/A | WCAIS screens or mail | N/A | N/A
497 | Physician's Affidavit of Recovery |  |  |  | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
499 | Petition for Physical Examination or Expert Interview of Employee (Section 314) | WCOA | Web/Fillable | Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
524 | Defendant's Answer to Occupational Disease Claim Petition Section 301(i) Only | WCOA | Web/Fillable | Upload/Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
550 | Claim Petition for Benefits from the Uninsured Employer and the Uninsured Employers Guaranty Fund | BWC/UEGF | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
603 | Petition for Review of Utilization Review Determination | WCOA | Web/Fillable | Mail | P | I | WCAIS screens or mail | Y | 2014-06-30 00:00:00
606 | Request for Hearing to Contest Fee Review Determination | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | N | 2014-06-30 00:00:00
749 | Death Claim Supplement to Compromise and Release Agreement |  |  |  | P | N/A | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
753 | Notice of Request for an Informal Conference | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
754 | Informal Conference Agreement Form | WCOA | Web/Fillable | Upload/Mail | P | I | N/A | N/A | N/A
755 | Compromise and Release Agreement by Stipulation Pursuant to Section 449 of the Workers' Compensation Act | WCOA | Web/Fillable | Upload/Mail | P | I | Upload or mail - no WCAIS screens | N/A | 2014-06-30 00:00:00
757 | Notice of Ability To Return To Work | BWC/Healthcare Services | Web | Online/Mail | P | I | Upload or mail - no WCAIS screens | Y | 2014-06-30 00:00:00
758 | Notice to Employee-Note: This form is to be attached to the LIBC-378 |  |  |  | P | N/A | N/A | Y | N/A