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Get Form Workers Compensation Injury Report 2002-2024

Rst knew of the injury. The 10 days to report begin either on the date of disability or the date the employer was notified, whichever date is later. 2. Give the name of the carrier. An insurance agency or third party administrator should be listed in the Preparer's Section. A carrier can pre-print its name and address in the Carrier Section to help clients properly report. 3. Specify the carrier Federal Employer Identification Number (FEIN) in the Carrier Section. 4. Type or print in ink. .

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