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WORKERS COMPENSATION FACT SHEET Jackson Public Schools (UPS) employees are covered under the MS Workers Compensation Act. The following is provided as a matter of information regarding workers compensation.

How to fill out workers compensation fact sheet

How to fill out a workers compensation fact sheet:

1. Begin by gathering all relevant information about the injured worker, such as their full name, contact information, and employment details.
2. Make sure to accurately document the date and time of the injury or incident that led to the workers compensation claim.
3. Describe the nature of the injury or illness in detail, including the body parts affected and the circumstances surrounding the incident. Be specific and include any medical reports or supporting documents if available.
4. Ensure that you provide a thorough and accurate account of the medical treatment received by the injured worker. Include the names of healthcare providers, dates of visits or hospital stays, and any medication or procedures that were administered.
5. Document the wages or income earned by the injured worker before the incident and any earnings they may have lost as a result of the injury. This can include regular salary, overtime, bonuses, and any other forms of compensation.
6. Indicate whether the injured worker has received or is currently receiving any other benefits or compensation related to their injury, such as disability benefits or social security payments.
7. Sign and date the workers compensation fact sheet, ensuring that all the information provided is accurate and complete. Keep a copy for your records and submit the form to the appropriate workers compensation department or insurance company.

Who needs a workers compensation fact sheet:

1. Employers: Employers are required by law to maintain workers compensation insurance and must accurately complete and submit workers compensation fact sheets for any employee who files a claim.
2. Injured workers: Those who have suffered a work-related injury or illness need to complete a workers compensation fact sheet to initiate a claim and document the necessary information for their case.
3. Insurance companies: Insurance companies rely on workers compensation fact sheets to evaluate claims and determine the appropriate benefits or compensation to provide to injured workers.
4. Legal representatives: Attorneys or legal professionals assisting injured workers or employers may require workers compensation fact sheets to review the case and provide legal advice or representation.
5. Government agencies: Government agencies responsible for overseeing workers compensation programs may request or require workers compensation fact sheets for auditing purposes or to ensure compliance with laws and regulations.

Remember, filling out a workers compensation fact sheet accurately and thoroughly is essential to ensure a smooth claims process and proper compensation for injured workers.

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