Form Libc 14B – Fill Out and Use This PDF

Form Libc 14B PDF Details

In the Commonwealth of Pennsylvania, the Department of Labor and Industry's Bureau of Workers' Compensation issues the LIBC-14B form, a critical document for those whose religious beliefs stand in contrast with the acceptance of standard workers' compensation benefits. This form serves as both an affidavit and a waiver, specifically tailored for employees who are devout members of religious sects with teachings that conscientiously object to the acceptance of any public or private insurance benefits. These benefits encompass those for death, disability, old age, retirement, or medical bills, including those under the Federal Social Security Act. By completing this form, an employee voluntarily forgoes rights to benefits under the Pennsylvania Workers’ Compensation Act, affirming their adherence to their religious beliefs. Additionally, it requires a statement from the religious sect leader, verifying the employee's active membership and the sect’s established tenets against accepting insurance benefits. This procedure not only respects the religious freedom of employees but also outlines a formal process for the waiver of workers' compensation benefits, ensuring that all parties are aware of the implications and the commitments being made.