- (a) A Supplemental Agreement for Compensation for Death, Form LIBC-339, may be used to change an Agreement for Compensation for Death, Form LIBC-338, or an award. A Supplemental Agreement for Compensation for Death, Form LIBC-339, shall be completed before being signed by an employer and a deceased’s dependents or personal representative.
(b) An Agreement for Compensation for Death, Form LIBC-338, shall be changed for any of the following reasons:
- (1) Birth of a posthumous child.
- (2) A change in dependent’s status, including death.
- (3) A surviving spouse dies, remarries or becomes capable of self-support and any dependent children remain eligible for benefits.
- (c) The Bureau will presume that the surviving parent is guardian for purposes of receiving compensation under the act.
- (d) The completed Supplemental Agreement for Compensation for Death, Form LIBC-339, shall be sent to all of the deceased’s dependents or their personal representative and filed with the Bureau.
Source
The provisions of this § 121.11 amended August 3, 2007, effective August 4, 2007, 37 Pa.B. 4181. Immediately preceding text appears at serial page (255594).