I got a Workers’ Compensation Verification Form in the mail. What is this?

by Karl Voigt

Some clients have asked us what to do with a Workers’ Compensation Verification Form they have received in the mail.

First of all, if you are an injured worker and are receiving benefits, the Workers’ Compensation carrier has the right to send you verification forms twice a year. They are in essence forms to document your receipt of wages or other benefits that might effect your Workers’ Compensation benefits. You must complete the forms and return them signed to the carrier. Otherwise, your benefits may be suspended until the forms are received.

There are essentially three forms that the carrier can send you to question your income. These forms will ask if you are earning wages, pension, unemployment, severance or Social Security Old Age benefits.

There is one trick to these forms: two of the forms are very, very similar. Namely, the LIBC-760 and LIBC-750 (a code found in the lower left of the form) are nearly identical. However, an important distinction must be made. If you fail to return the LIBC-760, your wage loss benefit checks can be suspended until you do. Failure to return the LIBC-750 does not allow the carrier to stop your checks. This distinction is critical because the forms are so similar; you could return only one form thinking you were sent doubles. If the one you returned was the LIBC-750 and not the LIBC-760, your benefits are in jeopardy.

We recommend that you return your forms via USPS certified mail, with a return receipt, so you can prove that you sent the forms back. Naturally, we would like a copy of the completed forms for our files.

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