Proper completion of Employee Verification Forms does matter for purposes of workers’ compensation. In the recent case of McCafferty v. W.C.A.B. (Trial Technologies, Inc.), No. 208 C.D. 2013, the Commonwealth Court held that Form LIBC-760, “Employee Verification of Employment, Self-Employment or Change in Physical Condition,” must be dated by the claimant. Insurers may submit LIBC-760s to employees at intervals of no less than six months. The employee is obligated to accurately complete the LIBC-760 and return it to the insurer within thirty days of receipt. If an employee fails to return the completed LIBC-760 within thirty days, the insurer is permitted to suspend compensation until the completed form is returned.
The Court explained that a signature and date are essential to the unsworn statement to the Department of Labor & Industry. The date is needed to confirm the substance of the statements contained in the LIBC-760 as of a date certain. Without a date, the LIBC-760 did not verify the claimant’s status at the time it was completed. Therefore, the LIBC-760 was not accurately completed, authorizing a suspension of workers’ compensation benefits.
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