Pennsylvania Form LIBC-337 is the Notice of Compensation Payable (NCP), the official document an insurer or self-insured employer files with the Pennsylvania Bureau of Workers’ Compensation to formally accept a work injury and start paying wage-loss and medical benefits. The form is issued under Section 407 of the Pennsylvania Workers’ Compensation Act, 77 P.S. § 1 et seq., and most carriers transmit it electronically through the WCAIS claims portal within the 21-day investigation window.
Getting LIBC-337 wrong is costly. Pennsylvania processes more than 170,000 work-injury claims a year, and an unreasonable delay or contest can trigger a 50% penalty plus 10% interest under Section 435 of the Act, payable on top of the underlying compensation.
Here is what this guide gives you:
- 📄 A line-by-line walkthrough of every box on LIBC-337, including the exact format the Bureau expects.
- 🧮 A plain-English method for calculating Average Weekly Wage (AWW) and the compensation rate so the math survives a judge’s review.
- 👷 Three filled-out examples — total disability, partial disability with modified duty, and a specific-loss finger amputation.
- ⏱️ The 21-day acceptance rule, the difference between LIBC-337, LIBC-495, and LIBC-496, and what happens if you miss the window.
- ❓ A 14-question FAQ that resolves the field-level confusion adjusters and injured workers ask most.
What the Form Is and Who Must File It
LIBC-337, titled Notice of Compensation Payable, is the carrier’s written admission that an injury is work-related and compensable. The form is published by the Bureau of Workers’ Compensation (BWC) inside the Department of Labor & Industry, and it puts the insurer on the record for wage-loss benefits, medical benefits, or both. Once filed, the NCP becomes the controlling document for that claim until it is modified, suspended, terminated, or set aside by a Workers’ Compensation Judge.
The filer is almost always the insurance carrier’s claims adjuster or, for self-insured employers, the in-house workers’ compensation administrator. Injured workers do not fill out LIBC-337; they receive a copy after it is issued. Attorneys representing injured workers should still know every field on the form because errors here often surface later as the basis for a penalty petition or a review petition.
A misconception worth correcting: many employers think signing the First Report of Injury (LIBC-344) accepts the claim. It does not. Acceptance happens only when LIBC-337, LIBC-336 (Agreement for Compensation), or LIBC-495 (Notice of Temporary Compensation Payable) is filed. Failing to issue one of these documents within 21 days of notice of disability exposes the carrier to penalty exposure under Section 406.1 of the Act.
Before You Start: Documents and Information You Need
Open the LIBC-337 only after the claim file is complete. The form is short, but every entry must match the source documents in the file, because the Bureau and any future judge will cross-check them. Missing data is the leading cause of rejected NCPs and delayed first checks.
Gather the following before you start typing inside WCAIS:
- Employee’s full legal name, address, Social Security Number, and date of birth — needed to match the worker to wage records and SSA files; mismatches stall indemnity payments.
- Employer’s legal name, mailing address, and FEIN — must match the policy of record on file with the Pennsylvania Compensation Rating Bureau.
- Insurance carrier’s name, address, NCCI carrier code, and policy number — wrong carrier codes route the NCP into the wrong claim queue.
- Date of Injury (DOI) and Date Disability Began (DDB) — these are not always the same date, and confusing them changes the compensation start date.
- Average Weekly Wage worksheet (LIBC-494A or LIBC-494C) — the Statement of Wages supports the AWW number you put on line 12.
- The 2026 Statewide Average Weekly Wage (SAWW) table — published yearly by the Department of Labor & Industry; the SAWW sets the maximum compensation rate.
- Medical reports and the panel-physician’s diagnosis — needed to describe the injury and body part in the language the Bureau expects.
- First Report of Injury (LIBC-344) — the foundation document; the NCP must be consistent with it.
- Authorized adjuster signature block, license number, and direct phone number — the Bureau rejects unsigned NCPs.
If any single item is missing, file an LIBC-495 (Notice of Temporary Compensation Payable) to start benefits within 21 days while you finish the investigation. The temporary NCP buys you 90 days, but it is not a substitute for LIBC-337 when liability is clear.
Where to Get the Form and How to Access It
The official LIBC-337 lives on the Bureau of Workers’ Compensation forms library, where you can download the current PDF revision. Always confirm the revision date printed in the lower-left footer matches the most recent Bureau release before you submit. Filing an obsolete revision is one of the top three reasons NCPs come back marked “rejected.”
Most filings now happen inside the Workers’ Compensation Automation and Integration System (WCAIS), the Bureau’s online portal. Carriers and TPAs that transmit through EDI Release 3.1 push the FROI/SROI 04 (Acceptance) transaction, and WCAIS auto-generates the LIBC-337 image from the EDI feed. Smaller self-insured employers without EDI capability can complete the fillable PDF and upload it directly to the WCAIS claim record.
Paper filing is still allowed but discouraged. If you must mail it, send the original to the Bureau of Workers’ Compensation, 1171 South Cameron Street, Room 324, Harrisburg, PA 17104-2501. Keep a stamped proof-of-mailing; the Bureau is not bound by a postmark date for the 21-day rule, only by the date it logs the filing. A misconception here: faxing LIBC-337 to the Bureau is not accepted. Fax submissions are routinely discarded.
Step-by-Step: How to Fill Out LIBC-337 Line by Line
The form is divided into a heading block, an identifying-information block (Boxes 1–11), a wage and compensation block (Boxes 12–17), an injury-description block (Boxes 18–22), and a signature block. Work through them in the order printed on the form so cross-references stay consistent.
Box 1: Employee Name
The field asks for the injured worker’s full legal name. Enter it in Last, First, Middle Initial order exactly as it appears on the worker’s Social Security card and driver’s license. Use upper-and-lower case; the Bureau’s OCR does not require all caps.
Example: Reyes, Marisol A.
Edge case: if the worker uses a hyphenated last name or a suffix (Jr., III), include the full string. A common mistake is entering a nickname like “Mari” instead of “Marisol,” which causes the SSA name match in WCAIS to fail and freezes the first indemnity check. A common misconception is that the name on the panel-physician’s chart controls; it does not. The Social Security record controls.
Box 2: Employee Social Security Number
The field asks for the worker’s nine-digit SSN. Enter it in XXX-XX-XXXX format with dashes; WCAIS strips the dashes during EDI translation, but the visual PDF requires them.
Example: 123-45-6789.
Edge case: for undocumented workers without a verified SSN, enter the Bureau-issued Individual Taxpayer Identification Number (ITIN) or the temporary Bureau identifier issued by WCAIS. A common mistake is leaving this blank “to protect privacy,” which the Bureau treats as an incomplete filing and rejects. A misconception some filers carry is that immigration status bars compensation; under Reinforced Earth Co. v. WCAB (Astudillo), undocumented workers are entitled to medical and specific-loss benefits in Pennsylvania.
Box 3: Employee Address
Enter the worker’s current mailing address, including apartment or unit number, city, state, and ZIP+4 where available. Use the address where the worker actually receives mail, not the home of record from the HR file.
Example: 4218 Liberty Ave., Apt. 3B, Pittsburgh, PA 15224-1907.
Edge case: if the worker has a P.O. Box, list the P.O. Box on the first line and the physical residence on the second line so the carrier can serve future documents. A common mistake is using an outdated address from payroll; checks returned by the post office trigger penalty exposure for nonpayment. A misconception is that the worker’s attorney’s address can substitute; it cannot, although the attorney must be copied separately.
Box 4: Employee Date of Birth
Enter the worker’s date of birth in MM/DD/YYYY format. The Bureau uses DOB along with SSN to disambiguate workers with common names.
Example: 03/14/1985.
Edge case: if the DOB on the I-9 differs from the DOB on the SSA record, use the SSA record and flag the discrepancy in the claim notes. A common mistake is entering today’s date by autofill habit, which silently corrupts the record. A misconception is that DOB is optional for adult workers; it is required on every NCP regardless of age.
Box 5: Employer Name
Enter the legal name of the employer as it appears on the workers’ compensation policy declarations page, not the trade name or “doing business as.” If the entity is an LLC or corporation, include the suffix.
Example: Keystone Logistics Holdings, LLC.
Edge case: for staffing agencies, list the staffing agency (the statutory employer) and reference the host employer in the description block. A common mistake is listing the parent company instead of the named insured, which mis-routes the claim against the wrong policy. A misconception is that DBA names are acceptable; the Bureau matches against the PCRB policy file, which only carries legal names.
Box 6: Employer Address
Enter the employer’s principal place of business, the location used on the policy. If the worker was injured at a job site different from the policy address, list the job-site address in Box 18 (description of injury), not here.
Example: 900 Industrial Blvd., Allentown, PA 18103.
Edge case: for remote workers, use the employer’s headquarters address; the worker’s home address goes in Box 3. A common mistake is putting the injury-site address here, which breaks the policy match in WCAIS. A misconception is that any employer location works; only the policy address triggers the correct carrier assignment.
Box 7: Employer FEIN
Enter the employer’s nine-digit Federal Employer Identification Number in XX-XXXXXXX format. The FEIN is the Bureau’s primary key for employer identity.
Example: 23-1456789.
Edge case: for governmental employers and certain non-profits with multiple FEINs, use the FEIN tied to the workers’ compensation policy, not the operating FEIN. A common mistake is using the parent corporation’s FEIN; this routes the claim away from the policy. A misconception is that the state UC account number substitutes; it does not.
Box 8: Insurance Carrier Name and Address
Enter the carrier’s legal name and address as listed on the PCRB carrier roster. For self-insured employers, write “Self-Insured” and the address of the claims-administration office.
Example: Liberty Mutual Insurance Company, 175 Berkeley St., Boston, MA 02116.
Edge case: if the policy is written by a captive or a fronting carrier, list the fronting carrier, because that is the entity bound by the NCP. A common mistake is listing the TPA instead of the carrier; the TPA goes in the signature block. A misconception is that “Self-Insured Group” can be used generically; the actual named SIG (e.g., Pennsylvania Manufacturers’ Association Group) is required.
Box 9: Carrier Code Number
Enter the four- or five-digit NCCI carrier code assigned to the insurer. The code is published in the NCCI Carrier Code list and on the policy declarations.
Example: 11860 (Liberty Mutual Fire Insurance Co.).
Edge case: self-insured employers use the Bureau-assigned self-insurance code, not an NCCI code. A common mistake is leaving this blank; WCAIS rejects EDI transactions without it. A misconception is that the carrier code is interchangeable across affiliates; each NCCI code maps to one underwriting entity.
Box 10: Policy Number
Enter the policy number exactly as printed on the declarations page, including any letter prefixes or hyphens. Match it character-for-character.
Example: WC7-31S-456789-026.
Edge case: if the injury occurred during a policy gap or on a renewal date, use the policy effective on the date of injury, not the date of filing. A common mistake is using the current renewal number for an older injury, which the PCRB policy match will reject. A misconception is that policy numbers are case-insensitive; they are not in EDI.
Box 11: Claim Number
Enter the carrier’s internal claim number. WCAIS will assign a separate Bureau claim number (“WC” number) once the filing posts; do not enter the WC number here.
Example: PA-2026-0098451.
Edge case: if the claim is being re-opened after a prior denial, use a new claim number and reference the old one in the notes. A common mistake is recycling a claim number from a denied claim, which causes WCAIS to flag a duplicate. A misconception is that the Bureau-assigned WC number goes in this field; it does not.
Box 12: Average Weekly Wage (AWW)
Enter the worker’s Average Weekly Wage, calculated under Section 309 of the Workers’ Compensation Act. The AWW is the higher of three 13-week averages from the year before the injury, or the contractual wage if the worker had been employed less than 13 weeks. Show the figure to two decimal places.
Example: $1,142.86.
Edge case: for seasonal workers, divide annual wages by 50; for concurrent employment, add wages from all covered Pennsylvania employers. A common mistake is averaging only the most recent 13 weeks; the statute requires the highest of the three quarterly averages. A misconception is that overtime is excluded; overtime, bonuses, and the reasonable value of board and lodging are included.
Box 13: Weekly Compensation Rate
Enter the weekly indemnity rate owed to the worker. For 2026 injuries, the rate is 66 2/3% of AWW, capped at the 2026 SAWW of $1,373.00, with sliding-scale rules for low-wage workers.
Example: $761.91.
Edge case: if AWW falls between 50% and 100% of the SAWW, use the sliding-scale formula; below 50%, the rate equals 90% of AWW. A common mistake is applying 66 2/3% without checking the cap or the floor, which underpays low- and high-wage workers and creates penalty exposure. A misconception is that the rate adjusts annually with the SAWW; it is locked at the date-of-injury rate for the life of the claim.
Box 14: Date of Injury
Enter the date the injury occurred in MM/DD/YYYY format. For repetitive-trauma or occupational-disease claims, use the date of last exposure or the date the worker first knew the condition was work-related, whichever is later.
Example: 01/12/2026.
Edge case: cumulative-trauma claims under Section 301(c)(2) use the last-day-worked date; document the rationale in the notes. A common mistake is using the date the claim was reported instead of the date of injury, which shifts the entire benefit timeline. A misconception is that the DOI must be a workday; injuries during paid travel, paid breaks, and bunkhouse cases can occur off-shift.
Box 15: Date Disability Began
Enter the first day the worker lost time from work because of the injury. This drives the compensation start date and the seven-day waiting period under Section 306(e).
Example: 01/15/2026.
Edge case: if the worker missed only partial days initially, use the first full day of lost time; if disability later reaches 14 days, the waiting period is retroactively payable. A common mistake is using the DOI as the DDB by default; if the worker finished the shift and returned the next day, DDB is later. A misconception is that DDB resets after a return-to-work; a recurrence is handled by a Supplemental Agreement (LIBC-337A), not a new NCP.
Box 16: Date of First Payment
Enter the date the carrier issued the first indemnity check. Under Section 406.1, this must be no later than the 21st day after notice of disability, unless a temporary NCP was filed.
Example: 02/02/2026.
Edge case: if the first check is mailed on day 21 but received on day 23, the mailing date controls — keep the postmark or EFT confirmation. A common mistake is dating the field to when the check was cut rather than mailed/transmitted; the Bureau looks at the transmission date. A misconception is that paying within 21 days from the DOI is enough; the clock runs from notice of disability, not the injury.
Box 17: Compensation Begin Date
Enter the date compensation actually begins to accrue, which is the eighth day of disability if disability is under 14 days, or the DDB itself if disability reaches 14 days. This field is distinct from Box 16.
Example: 01/22/2026.
Edge case: for specific-loss claims, compensation begins on the DDB regardless of the seven-day waiting period because specific-loss is not wage-loss based. A common mistake is conflating Compensation Begin Date with First Payment Date; they answer different questions. A misconception is that the waiting period is unpaid forever; it becomes payable retroactively once disability hits 14 days.
Box 18: Description of Injury and Body Part
Describe the injury in anatomical, plain-English terms — name the body part, the side (left/right), and the diagnosis. Match the panel physician’s report; vague descriptions invite later litigation over scope of acceptance.
Example: Herniated disc at L4-L5 with right lumbar radiculopathy, sustained while lifting a 75-lb pallet.
Edge case: for psychological injuries, include both the physical trigger (if any) and the DSM-5 diagnosis. A common mistake is writing “back injury” with no level or laterality, which lets the worker later add unrelated conditions to the claim. A misconception is that broad descriptions protect the carrier; under Cinram Mfg. v. WCAB (Hill), an overly broad NCP can be read against the carrier.
Box 19: How the Injury Occurred
Provide a one- to three-sentence narrative of the mechanism of injury — what the worker was doing, what went wrong, and where. Use the worker’s own statement plus the supervisor’s report.
Example: While loading a delivery truck at the Allentown terminal, the worker bent and twisted to lift a 75-lb pallet of beverages, feeling a sudden pop in the lower back.
Edge case: for assault, motor-vehicle, or third-party injuries, note the third party so subrogation under Section 319 is preserved. A common mistake is copying the LIBC-344 verbatim without proofreading; inconsistencies between the two documents become impeachment material. A misconception is that this field can be left blank “pending investigation”; the Bureau treats blank as incomplete.
Box 20: Location of Injury
Enter the physical address or job site where the injury happened. For in-transit injuries, list the route or the closest cross-street.
Example: Keystone Logistics Allentown Terminal, 900 Industrial Blvd., Allentown, PA 18103.
Edge case: for traveling employees, include city and county; venue of any later litigation may depend on it. A common mistake is using the employer’s headquarters when the worker was injured elsewhere; venue then defaults incorrectly. A misconception is that this field is informational only; it controls the workers’ compensation judge district assignment.
Box 21: Compensation Payable For
Check the box(es) indicating whether compensation is payable for total disability, partial disability, specific loss, disfigurement, or death. More than one may apply.
Example: ☒ Total Disability.
Edge case: a specific-loss claim that also involves wage loss during healing should check both Specific Loss and Total Disability. A common mistake is checking only the worker’s current status without considering future scheduled benefits; under Section 306(c) the carrier owes specific loss even after return-to-work. A misconception is that checking Partial Disability waives the 500-week cap; the cap applies by operation of law, not by the check-box.
Box 22: Medical-Only Indicator
If the claim is medical-only (no lost time beyond seven days), check this box. A medical-only NCP still must be issued under Bureau practice, although some carriers historically used informal payment.
Example: ☒ Medical-Only.
Edge case: if the worker later loses 14 or more days, convert with a Supplemental Agreement (LIBC-337A) rather than a new NCP. A common mistake is closing a medical-only file without an NCP, leaving the worker without a formal acceptance document. A misconception is that medical-only claims do not require Bureau filing; they do, under Bureau Document Filing Requirements.
Signature Block: Adjuster Certification
The bottom of the form requires the printed name, signature, title, telephone number, and date of the carrier representative authorized to bind coverage. WCAIS captures the EDI sender ID as the electronic signature for online filings.
Example: Daniel O’Connor, Senior Claims Adjuster, Liberty Mutual, (610) 555-0142, 02/02/2026.
Edge case: TPAs sign in their own name but must include the carrier’s name on the line above. A common mistake is leaving the date blank or post-dating the signature, which undermines the 21-day proof. A misconception is that an unsigned NCP is curable later; the Bureau treats unsigned filings as void from inception.
Three Filled-Out Examples Using Real Scenarios
Example 1 — Carlos Mendez, Construction Worker (Total Disability)
Carlos is a 38-year-old union carpenter who fell from a scaffold on a Philadelphia job site and fractured his right tibia. He has been out of work for six weeks with surgery planned, and his AWW from the prior 52 weeks is $1,425.00.
| Form Section | What Carlos’s Adjuster Enters |
|---|---|
| Box 1 — Employee Name | Mendez, Carlos R. |
| Box 4 — Date of Birth | 07/22/1987 |
| Box 12 — Average Weekly Wage | $1,425.00 |
| Box 13 — Weekly Compensation Rate | $950.00 (66 2/3% of AWW, under SAWW cap) |
| Box 14 — Date of Injury | 03/05/2026 |
| Box 15 — Date Disability Began | 03/05/2026 |
| Box 17 — Compensation Begin Date | 03/12/2026 (8th day) |
| Box 18 — Description of Injury | Comminuted fracture, right tibia and fibula, with ORIF surgery |
| Box 21 — Compensation Payable For | ☒ Total Disability |
Example 2 — Aisha Carter, Retail Cashier (Partial Disability with Modified Duty)
Aisha is a 29-year-old grocery cashier who sustained a right rotator-cuff tear lifting cases of water. She returned to modified light-duty at the customer-service desk earning $480/week against a pre-injury AWW of $720.00.
| Form Section | What Aisha’s Adjuster Enters |
|---|---|
| Box 1 — Employee Name | Carter, Aisha M. |
| Box 4 — Date of Birth | 11/08/1996 |
| Box 12 — Average Weekly Wage | $720.00 |
| Box 13 — Weekly Compensation Rate | $480.00 (66 2/3% of AWW; partial paid as 2/3 of wage loss) |
| Box 14 — Date of Injury | 02/18/2026 |
| Box 15 — Date Disability Began | 02/19/2026 |
| Box 18 — Description of Injury | Partial-thickness tear, right rotator cuff (supraspinatus) |
| Box 19 — How Injury Occurred | Lifting a case of 24 water bottles from floor pallet to register belt |
| Box 21 — Compensation Payable For | ☒ Partial Disability |
Example 3 — Janet Whitfield, Machinist (Specific Loss — Finger Amputation)
Janet is a 54-year-old CNC operator who amputated the distal phalanx of her left index finger in a press incident. She returned to full-duty work after three weeks but is owed scheduled specific-loss benefits.
| Form Section | What Janet’s Adjuster Enters |
|---|---|
| Box 1 — Employee Name | Whitfield, Janet L. |
| Box 4 — Date of Birth | 09/30/1971 |
| Box 12 — Average Weekly Wage | $1,050.00 |
| Box 13 — Weekly Compensation Rate | $700.00 (66 2/3% of AWW) |
| Box 14 — Date of Injury | 04/01/2026 |
| Box 17 — Compensation Begin Date | 04/01/2026 (no waiting period for specific loss) |
| Box 18 — Description of Injury | Traumatic amputation, distal phalanx, left index finger |
| Box 21 — Compensation Payable For | ☒ Specific Loss ☒ Total Disability (healing period) |
| Box 22 — Medical-Only Indicator | ☐ (not checked — specific loss is indemnity) |
How to File the Completed Form
Pennsylvania accepts LIBC-337 through three channels, and the timing of each is governed by the 21-day rule in Section 406.1. The most common channel today is electronic.
- EDI Release 3.1 Transmission. Large carriers and TPAs send the FROI/SROI 04 transaction through their EDI vendor to the Bureau’s gateway. There is no filing fee. Processing is real-time; WCAIS posts the NCP to the claim record within 24 hours, and the EDI acknowledgement (TA/TR) is the proof-of-filing — save it to the claim file.
- WCAIS Web Form Upload. Self-insured employers and smaller carriers without EDI capability log into WCAIS, open the claim, and upload the signed PDF. No fee. Processing posts within one to two business days, and the WCAIS confirmation screen plus the email receipt are proof-of-filing.
- Paper Filing by Mail. Send the original signed LIBC-337 to Bureau of Workers’ Compensation, 1171 South Cameron Street, Room 324, Harrisburg, PA 17104-2501. No fee. Processing takes 7–14 business days. Use certified mail with return receipt and keep the green card as proof; faxed and emailed submissions are not accepted.
Whichever channel you use, serve a copy on the worker and the worker’s attorney by first-class mail the same day the NCP is filed with the Bureau. Failure to serve is itself a basis for a penalty petition.
What Happens After You File
Once LIBC-337 posts, WCAIS issues a Bureau claim number (“WC” number) and the claim is officially “accepted.” The carrier’s obligation to pay weekly indemnity continues until the claim is modified by a Notification of Suspension or Modification (LIBC-751), a Supplemental Agreement, or a Workers’ Compensation Judge order.
The worker has the right to challenge the AWW or the description of injury by filing a Review Petition within three years of the most recent compensation payment under Section 413(a) of the Act. Adjusters should expect a review petition any time the AWW seems light or the injury description seems narrow.
If the carrier later concludes the claim should have been denied, it cannot simply rescind the NCP. The carrier must file a Termination, Suspension, or Modification Petition and prove the basis before a Workers’ Compensation Judge. A misconception worth correcting: filing LIBC-337 in error is not curable by filing LIBC-496 (Denial) afterward; once accepted, only a judge or a signed Compromise & Release Agreement (LIBC-755) ends the obligation.
Mistakes to Avoid When Filling Out the Form
- Using the wrong revision date. The Bureau rejects outdated LIBC-337 versions, restarting your 21-day clock at zero.
- Confusing Date of Injury with Date Disability Began. This shifts compensation start and creates underpayment or overpayment exposure.
- Miscalculating Average Weekly Wage. Skipping the highest-of-three-quarters rule under Section 309 generates penalty petitions.
- Ignoring concurrent employment. Omitting a second covered employer’s wages understates AWW and invites a review petition.
- Vague injury description. Writing “back injury” without level or laterality lets the worker expand the claim later.
- Listing the trade name instead of the legal employer. The PCRB policy match fails and the claim mis-routes.
- Leaving the carrier code blank. WCAIS rejects EDI transactions without a valid NCCI carrier code.
- Skipping service on the worker. Filing with the Bureau without mailing the worker is grounds for penalties.
- Filing LIBC-337 when LIBC-495 was intended. You lose the 90-day temporary-acceptance window and lock in liability prematurely.
- Unsigned signature block. The Bureau treats unsigned NCPs as void, and the 21-day clock keeps running.
- Using a fax submission. Faxed NCPs are discarded; only EDI, WCAIS upload, or certified mail count.
- Failing to convert a medical-only claim. When disability hits 14 days, missing the LIBC-337A supplemental triggers penalty exposure.
Do’s and Don’ts
- Do confirm the AWW with the LIBC-494A Statement of Wages before entering Box 12, because the worksheet is the audit trail if the rate is challenged.
- Do file LIBC-495 first when liability is uncertain, because the 90-day temporary acceptance preserves your defenses.
- Do match the employer name exactly to the policy declarations, because PCRB matching is character-sensitive.
- Do serve the worker the same day you file with the Bureau, because service is independently penalty-bearing.
- Do keep the EDI TA/TR acknowledgement as your proof-of-filing, because the Bureau will not re-issue confirmations.
- Do describe the injury anatomically with side and level, because vague descriptions are read against the carrier under Cinram.
- Don’t recycle a denied-claim claim number, because WCAIS flags it as a duplicate and rejects the filing.
- Don’t post-date the signature, because the date controls the 21-day proof.
- Don’t paraphrase the box labels, because the Bureau matches against the exact field names on the current revision.
- Don’t file LIBC-337 by fax or email, because the Bureau will not log it.
- Don’t assume the SAWW cap doesn’t apply, because high-wage workers without the cap result in overpayments you cannot recoup.
- Don’t issue LIBC-496 after LIBC-337, because acceptance cannot be unilaterally rescinded.
Pros and Cons of Filing on Your Own vs. With Help
- Pro — Adjuster-only filing is fast. A seasoned adjuster can complete LIBC-337 in under 15 minutes when wage and medical documents are in hand.
- Pro — Direct EDI control. The carrier owns the timeline and does not depend on outside counsel for routine acceptances.
- Pro — Lower cost. No legal fees attach to a straightforward accepted claim, preserving reserves.
- Pro — Preserves the worker relationship. Quick voluntary acceptance signals good faith and reduces litigation risk.
- Pro — Cleaner data in WCAIS. Adjusters who own the field-level entries can correct typos immediately.
- Con — Field-level errors are easy to make. AWW miscalculations, vague descriptions, and wrong dates all generate later litigation.
- Con — Adjusters may miss subrogation cues. A third-party fact pattern in Box 19 needs counsel’s eye to preserve Section 319 rights.
- Con — Pre-existing condition issues require legal input. Aggravation vs. recurrence drives whether to file LIBC-337 or LIBC-496.
- Con — Mental-injury and occupational-disease claims are technical. These claims often need defense counsel to evaluate before acceptance.
- Con — Self-represented self-insureds can mis-route policy data. Without counsel and a PCRB check, the NCP can post against the wrong policy year.
LIBC-337 vs. LIBC-495 vs. LIBC-496
The three documents collectively cover the carrier’s options at day 21, and choosing among them is the single most important decision in early claim handling.
| Form | When to Use It |
|---|---|
| LIBC-337 — Notice of Compensation Payable | Carrier accepts the claim outright; liability is clear and benefits begin on a permanent footing |
| LIBC-495 — Notice of Temporary Compensation Payable | Carrier needs up to 90 days to investigate; benefits begin without admitting liability |
| LIBC-496 — Notice of Compensation Denial | Carrier denies the claim; must state the specific reason for denial (e.g., not work-related, not an employee) |
FAQs
Do I file LIBC-337 if the worker missed only one day of work?
Yes. A medical-only LIBC-337 (Box 22 checked) is still appropriate, because the Bureau requires an acceptance document on every compensable injury regardless of lost-time duration.
Do I have to use WCAIS, or can I still mail the form?
No. WCAIS is not mandatory for non-EDI filers; certified mail to the Bureau in Harrisburg is still accepted, though slower and less reliable than electronic filing.
Is the 21-day deadline measured from the date of injury or the date of disability?
No. The 21 days run from the date the employer has notice of disability, not the date of injury, under Section 406.1 of the Act.
Do I write the legal name or the DBA in Box 5?
No. Never use the DBA; Box 5 takes the legal name on the workers’ compensation policy declarations page, because the PCRB matches against the legal name.
Do I include overtime in the AWW on Box 12?
Yes. Overtime, shift differentials, bonuses, and the reasonable value of board and lodging are all included under Section 309 of the Act.
Do I list the staffing agency or the host employer in Box 5?
Yes, list the staffing agency as the named insured employer, because the staffing agency is the statutory employer carrying the workers’ compensation policy.
Do I need the worker’s signature on LIBC-337?
No. Only the carrier or self-insured employer signs; the worker is served a copy but does not sign the NCP.
Is the weekly compensation rate the same as 66 2/3% of AWW for every worker?
No. The rate is 66 2/3% only in the mid-band; low-wage workers use 90% of AWW, and high-wage workers are capped at the SAWW for the year of injury.
Do I file a new LIBC-337 if the worker has a recurrence after returning to work?
No. Use a Supplemental Agreement (LIBC-337A) to reinstate benefits, because the original NCP still controls the underlying claim.
Can I rescind LIBC-337 if I find out later the injury wasn’t work-related?
No. Once filed, acceptance can be undone only by a judge’s order, a Compromise & Release, or a successful Termination Petition.
Do undocumented workers receive LIBC-337 benefits?
Yes, for medical and specific-loss benefits under Reinforced Earth v. WCAB; wage-loss benefits may be suspended once the worker is able to return to any work.
Do I check both Total Disability and Specific Loss on Box 21 for an amputation?
Yes, when the worker has a healing period of lost time before returning to work, both boxes apply, because the healing period is wage-loss and the specific loss is scheduled.
Is there a filing fee for LIBC-337?
No. Pennsylvania charges no filing fee for any LIBC form, including LIBC-337, regardless of filing channel.
Do I need to attach the LIBC-494A Statement of Wages to the NCP?
No, the LIBC-494A is filed separately in WCAIS as a wage document, but you must complete and retain it as the audit trail for Box 12.
Related reading
- How to Fill Out Pennsylvania Form LIBC-336 (w/Examples) + FAQs
- How to Fill Out Pennsylvania Form LIBC-344 (w/Examples) + FAQs
- How to Fill Out Pennsylvania Form LIBC-501 (w/Examples) + FAQs
- How to Fill Out Pennsylvania Form LIBC-378 (w/Examples) + FAQs
- How to Fill Out Pennsylvania Form LIBC-410 (w/Examples) + FAQs
- How to Fill Out Pennsylvania Form LIBC-757 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs