Third Party Settlement Agreement {LIBC-380}

LIBC-380 -- THIRD PARTY SETTLEMENT AGREEMENT. This form is used by the Pennsylvania Department of Labor & Industry, Bureau of Workers' Compensation when there is a settlement involving a third party in a workers' compensation case. The form includes calculation instructions for determining the distribution of proceeds from the third-party recovery. It outlines the total amount of the third-party recovery, accrued workers' compensation lien, expenses of recovery, and the net lien to be received by the employer. Furthermore, the form includes sections for the present distribution of proceeds and future distribution of proceeds, detailing how much the employer must reimburse the employee for expenses used to acquire the third-party recovery on future compensation liability. www.FormsWorkflow.com