§ 123.3. Employee report of benefits subject to offset.
(a) Employees shall report to the insurer amounts received in unemployment compensation, Social Security (old age), severance and pension benefits on form LIBC-756, ‘‘Employee’s Report of Benefits.’’ This includes amounts withdrawn or otherwise utilized from pension benefits which are rolled over into an IRA or other similarly restricted account while at the same time the employee is receiving workers’ compensation benefits.
(b) Form LIBC-756 shall be completed and forwarded to the insurer within 30 days of the employee’s receipt of any of the benefits specified in subsection (a) or within 30 days of any change in the receipt of the benefits specified in subsection (a), but at least every 6 months.
Cross References This section cited in 34 Pa. Code § 123.4 (relating to application of the offset generally); and 34 Pa. Code § 123.5 (relating to offset for benefits already received).
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