Fillable ITEMIZED STATEMENT OF COMPENSATION (DWC-50) - dlt ri

Description
ITEMIZED STATEMENT OF COMPENSATION (DWC-50) General Instructions: Completed by: Claim Administrator. Time Frame: Within 60 days after the discontinuance or suspension of compensation payments. Distribution: Original to Department of Labor and Training (DLT). Copy to the employee and his or her attorney and also to the employer, if filed by the insurer. Attachments: None. Definitions: PLEASE CHECK IF CORRECTION OF...
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