1. (a) If a compensable injury results in death, an Agreement for Compensation for Death, Form LIBC-338, shall be executed between an employer and the deceased’s dependents or personal representative and filed with the Bureau. An Agreement for Compensation for Death, Form LIBC-338, shall be completed before being signed by an employer and a deceased’s dependents or personal representative.
2. (b) A Statement of Wages, Form LIBC-494A, or Statement of Wages, Form LIBC-494C, shall be filed with every Agreement for Compensation for Death, Form LIBC-338.
3. (c) If death results from the injury, compensation payments to the dependents for the death benefit shall begin from the date of the employee’s death.
4. (d) If the employer has not obtained the wages necessary to properly calculate the employee’s compensation payable, an Agreement for Compensation for Death, Form LIBC-338, based on the employee’s estimated wages may be filed. The estimated Agreement for Compensation for Death, Form LIBC-338, shall be clearly identified as ‘‘Estimated.’’

5. (e) If the estimated wages or compensation is not correct, the employer shall amend the estimated Agreement for Compensation for Death, Form LIBC-338, upon receipt of the employee’s actual wages.

   1. (1) Amendments resulting in an increase in the employee’s wage or dependent’s compensation shall be filed with the Bureau under § 121.12 (relating to Bureau review of agreements and notices of compensation payable), and shall be clearly identified as ‘‘Amended.’’
   2. (2) The employer shall file a Supplemental Agreement for Compensation for Disability or Permanent Injury, Form LIBC-337, under § 121.17 (relating to change in compensation) when there are changes resulting in a decrease in the employee’s wage or compensation.

Source

The provisions of this § 121.9 amended August 3, 2007, effective August 4, 2007, 37 Pa.B. 4181. Immediately preceding text appears at serial page (255593).