Pennsylvania Form LIBC-14C: Workers’ Comp Religious Exception Filing and Reissue

Pennsylvania Form LIBC-14C is the Certification of Religious Exception that the Bureau of Workers’ Compensation issues to an employee after it approves a religious exemption from the Pennsylvania Workers’ Compensation Act under Section 304.2. It is not a blank form you download and complete. You receive it from the Bureau, and once you hold one it stays valid for future jobs unless you leave the religious sect or the sect itself stops meeting the statutory requirements.¹

How to Get a LIBC-14C the First Time

You do not file for the exemption yourself. Your employer files Form LIBC-14A, Application for Religious Exception of Specified Employees, and submits supporting documentation for each employee being exempted. If multiple employees of the same employer want the exemption, they can all be listed on one LIBC-14A.²

For a first-time applicant, the supporting document is Form LIBC-14B, the Employee’s Affidavit and Waiver of Workers’ Compensation Benefits and Statement of Religious Sect. The LIBC-14B has two parts on a single form. In the first part, you swear under oath that you belong to the named religious sect, that the sect’s established teachings oppose accepting insurance benefits, that you adhere to those teachings, and that you knowingly and voluntarily waive all rights to benefits under the Pennsylvania Workers’ Compensation Act. That signature must be notarized. In the second part, a leader or authorized representative of your religious organization verifies your membership, confirms the sect’s teachings, and attests that the sect provides for its dependent members.³

Filing misleading or incomplete information on purpose violates Section 1102 of the Workers’ Compensation Act and can trigger criminal and civil penalties under Pennsylvania’s insurance fraud statute.³

If the Bureau approves the application, it issues your LIBC-14C. If you already hold an approved IRS Form 4029 (the federal Social Security and Medicare tax exemption for members of the same qualifying religious groups), you can submit that in place of the LIBC-14B.²

Using Your LIBC-14C With a New Employer

This is where the certification earns its keep. When you change jobs, your new employer files a fresh LIBC-14A and simply attaches your existing LIBC-14C. You do not have to complete another LIBC-14B, and you do not have to find a notary again.² The new employer does not need to belong to your religious sect; the eligibility requirements fall on you, not on the business.

Give your new employer a clean copy of the LIBC-14C along with any information they need to complete the LIBC-14A. Keep the original in your own records.

If You Lose Your LIBC-14C

Without the certification in hand, your new employer cannot use the shortcut. You would likely need to run through the LIBC-14B affidavit and notarization again, or produce an approved IRS Form 4029, so the Bureau has a basis to issue a new approval. Treat the LIBC-14C like other important government paperwork and keep a backup copy.

Who Qualifies

The exemption is available to employees who belong to a recognized religious sect whose established teachings oppose accepting benefits from public or private insurance, including payments related to death, disability, old age, retirement, and medical costs, as well as federal Social Security benefits. The Bureau approves the application if it finds that you genuinely belong to such a sect and that the sect has, for a substantial number of years, provided for its own dependent members at a level the Department considers reasonable. A completed LIBC-14B is treated as initial proof of both conditions.¹

Where the Employer Files

The employer can submit the LIBC-14A and its supporting documents four ways:

By mail to PA Department of Labor & Industry, Bureau of Workers’ Compensation/Compliance Office, 651 Boas Street, 8th Floor, Harrisburg, PA 17121-0750.
Online through the Workers’ Compensation Automation and Integration System (WCAIS) at www.dli.pa.gov/WCAIS, using a Keystone ID login and selecting the religious exception option from the dashboard.
By fax to 717-214-5264.
By email to ra-libwc-compliance@pa.gov.

The Bureau’s instructions and the statute do not reference a filing fee.² The blank LIBC-14A and LIBC-14B are available as PDFs on the Department of Labor & Industry’s workers’ compensation forms page, under the BWC and OCR forms section. The LIBC-14C is not there, because it is only issued by the Bureau after approval.⁴

After Approval and If the Exemption Lapses

Your employer should keep the approved LIBC-14C accessible at the place of employment. The Bureau’s Compliance Office may ask to see documentation of the exemption.⁵

The employer must notify the Bureau if you stop qualifying for the exception, whether because you leave the sect or for any other reason.² If the exemption lapses and the employer keeps you on without workers’ compensation coverage, the penalties are steep. A misdemeanor conviction can bring a fine of up to $2,500 and up to one year in jail for each day out of compliance, and an intentional felony violation can bring fines up to $15,000 and up to seven years of imprisonment per day.⁶

1
Pennsylvania General Assembly. Pennsylvania Code 77 P.S. 484 – Exemption From Coverage; Religious Beliefs; Application
2
Pennsylvania Department of Labor & Industry. Instructions for Religious Exception Application
3
Pennsylvania Department of Labor & Industry. Employee’s Affidavit and Waiver of Workers’ Compensation Benefits and Statement of Religious Sect
4
Commonwealth of Pennsylvania. Quick Reference Guide to LIBC Forms – BWC Forms
5
Department of Labor and Industry. Workers’ Compensation Compliance
6
Pennsylvania Department of Labor & Industry. PA Workers’ Compensation Employer Information