Get the free DWC Form 10005 - State of California - dir ca
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SAVE PRINT CLEAR Request for Reimbursement of Accommodation Expenses For injuries on or after July 1, 2004, Form DWC AD 10005 Name of Employer: Address of Employer: Phone Number: Name of Injured Employee:
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What is dwc form 10005?
DWC Form 10005 is a form used in the workers' compensation system to report an injury or illness that requires medical treatment beyond first aid.
Who is required to file dwc form 10005?
Employers or insurance carriers are usually required to file DWC Form 10005 when an employee suffers a work-related injury or illness that requires medical treatment beyond first aid.
How to fill out dwc form 10005?
To fill out DWC Form 10005, you must provide information such as the injured employee's personal details, the nature of the injury or illness, the medical treatment received, and any related expenses. The form should be completed accurately and submitted according to the instructions provided by the workers' compensation system.
What is the purpose of dwc form 10005?
The purpose of DWC Form 10005 is to document and report work-related injuries or illnesses that require medical treatment beyond first aid. This information helps in assessing the impact on the employee, determining eligibility for workers' compensation benefits, and tracking workplace safety and health data.
What information must be reported on dwc form 10005?
DWC Form 10005 requires information such as the injured employee's name, contact details, date and time of injury or onset of illness, description of the injury or illness, medical treatment received, and related expenses.
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