Agreement For Compensation For Death {LIBC-338} | Pdf Fpdf Docx | Pennsylvania

 Pennsylvania   Workers Comp 
Agreement For Compensation For Death {LIBC-338} | Pdf Fpdf Docx | Pennsylvania

Last updated: 4/3/2024

Agreement For Compensation For Death {LIBC-338}

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Description

LIBC-338 -- AGREEMENT FOR COMPENSATION FOR DEATH. This form is used by the Pennsylvania Department of Labor & Industry, Bureau of Workers' Compensation to formalize an agreement between the dependents of a deceased employee, the employer, and the insurer or third-party administrator regarding compensation rights and amounts following the death of an employee due to a work-related incident. The form includes detailed information about the deceased employee, the dependents or personal representative, injury information, employer details, insurer or third-party administrator information, compensation details, and signatures from all relevant parties. www.FormsWorkflow.com

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