PLEASE NOTE: The following important Notice was published via WCAIS on 01/14/2022:
Notification of Suspension or Modification (LIBC-751) Revised
On Dec. 22, 2021, Governor Tom Wolf signed Act 95 (House Bill 1837) into law. This act amended Section 413(c) & (d) of the PA Workers Compensation Act such that an affidavit is no longer required on the Notification of Suspension or Modification Pursuant to 413(c) & (d) – LIBC 751, effective Feb. 20, 2022.
The Bureau of Workers Compensation has revised the Notification of Suspension or Modification, LIBC-751, to comply with Act 95. The notification now includes two verification boxes which must be checked before the document is signed. The notification must still be sent to the claimant and the bureau within seven days of the modification or suspension of benefits. Due to the substantive change to the form, the revised form must be used beginning Feb. 20, 2022. After March 2, 2022, prior versions of the form will be marked incomplete.
Please upload completed forms into WCAIS. Filing in WCAIS is available 24/7 and reflects a “filed date” when uploaded. This practice offers cost savings, timely filing to the bureau without the need for a valid US Post Mark and makes the document available for instant viewing by all parties to the claim. Uploading can be done within the Action Tab of a claim, using the “Document Type” Notification of Suspension or Modification (LIBC-751) in the tab’s drop-down list. The form may also be mailed to the bureau for filing.
The revised form is available at:
https://www.dli.pa.gov/Businesses/Compensation/WC/claims/wcais/Documents/wcais forms/LIBC-751 print.pdf