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3250 Interstate Drive, Rich field, Ohio 44286-9000 800-929-1500 Fax: 330-659-8905 www.natl.com National Interstate Insurance Company National Interstate Insurance Company HI Triumph Casualty Company

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What is workers' compensation application?

Workers' compensation application is a form filed by an employee who has been injured on the job to request for compensation for medical expenses and lost wages.

Who is required to file workers' compensation application?

Employees who have suffered a work-related injury or illness are required to file a workers' compensation application.

How to fill out workers' compensation application?

Workers can fill out the application form provided by their employer or the workers' compensation board with details of their injury, medical treatment, and any witnesses.

What is the purpose of workers' compensation application?

The purpose of the workers' compensation application is to seek financial compensation for medical expenses and lost wages incurred due to a work-related injury or illness.

What information must be reported on workers' compensation application?

The workers' compensation application must include details of the injury, medical treatment received, dates of absence from work, and any witnesses to the incident.

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