PA LIBC-372 2017-2026 free printable template

VEIN: Applicant×Employer Name:Initial Application for Safety Committee Certification (LIBC372×www.dli.pa.govHealth and Safety DivisionAuxiliary aids and services are available upon request to individuals

How to fill out PA LIBC-372

How to fill out PA LIBC-372

1. Obtain the PA LIBC-372 form from the appropriate website or office.
2. Read the instructions carefully to understand what information is required.
3. Fill out your personal information in the designated fields, including your name, address, and contact information.
4. Provide details about your employment, including the name of your employer and dates of employment.
5. Describe the reason you are filing for benefits, ensuring to include relevant dates and any supporting information.
6. Review the completed form for accuracy and completeness.
7. Sign and date the form to verify that all information provided is true and correct.
8. Submit the form to the appropriate agency as instructed.

Who needs PA LIBC-372?

1. Individuals who are filing for workers' compensation benefits in Pennsylvania.
2. Employees who have suffered a work-related injury or illness.
3. Anyone seeking to claim compensation for lost wages or medical expenses resulting from a workplace incident.

People Also Ask about

Do I need workers comp insurance in PA?

Workers' compensation coverage is mandatory for most employers under Pennsylvania law. Employers who do not have workers' compensation coverage may be subject to lawsuits by employees and to criminal prosecution by the commonwealth.

What is the minimum payroll for an officer in PA?

Adjustment necessary to bring executive officers to corporate minimum payroll (currently all executive officers have a minimum payroll of $56,212.00 annually or $1,081.00 per week effective 4/1/2021 and maximum payroll $140,000.00.

Who is exempt from workers comp in Pennsylvania?

Sole proprietors. Employees not working within the regular course of the employer's business. Agricultural workers hired to do less than 30 days of work and who earn less than $1,200/year from one employer. Employees who request an exemption based on religious beliefs or executive status in certain corporations.

What is the minimum payroll for workers comp officers in PA?

Workers' Comp Exemptions in Pennsylvania Sole-Proprietors and Partners who include themselves on workers' compensation coverage must use a minimum payroll amount of $58,760 and a maximum amount of 148,200 for rating their overall workers' compensation cost in 2023.

How much does an employer pay for workers compensation in PA?

Workers' Compensation is tax-free. In Pennsylvania, the weekly compensation rate amounts to 66% of the injured worker's average weekly wage if they earned between $810.76 and $1,621.50 prior to the injury. For workers who earn between $600.56 and $810.75, the weekly compensation rate is $540.50.

What does workers comp cover in PA?

Workers' compensation covers the cost of medical care for workplace injuries and occupational diseases. That includes everything from carpal tunnel syndrome to back injuries and black lung disease. It also provides partial wage replacement while the employee is unable to work.

What is the employer's first report of injury in PA?

Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

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What is PA LIBC-372?

PA LIBC-372 is a form used in the state of Pennsylvania for reporting and documenting specific information related to workers' compensation insurance.

Who is required to file PA LIBC-372?

Employers who are required to provide workers' compensation insurance coverage for their employees must file PA LIBC-372.

How to fill out PA LIBC-372?

To fill out PA LIBC-372, employers should enter the required information regarding their workers' compensation insurance policy, including the policy number, coverage details, and any relevant employee information.

What is the purpose of PA LIBC-372?

The purpose of PA LIBC-372 is to provide a standardized method for employers to report their workers' compensation coverage to the Pennsylvania Department of Labor and Industry.

What information must be reported on PA LIBC-372?

PA LIBC-372 must report information such as the employer's name, address, insurance carrier details, policy number, and effective dates of coverage.