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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION SECOND INJURY FUND SURCHARGE FOR QUARTER ENDING Insurance Company Name, Address and NAIL Number $ $1. New or
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How to fill out second injury fund surcharge
How to fill out second injury fund surcharge:
01
Begin by gathering all the necessary information and documents, such as the relevant forms and any supporting documentation required by your state's workers' compensation agency.
02
Carefully review the instructions provided with the second injury fund surcharge form to ensure that you understand all the requirements and obligations.
03
Fill out the form accurately and completely, providing all the requested information. This may include details about the injured employee, their previous injuries or disabilities, and any existing workers' compensation claims.
04
Attach any required supporting documentation, such as medical records or disability evaluations, to provide evidence for the second injury fund surcharge.
05
Double-check all the information filled in the form and review it for any errors or omissions. It is important to ensure the accuracy of the information provided to avoid any complications or delays with the processing of the surcharge.
06
Submit the completed form and accompanying documents to the appropriate state workers' compensation agency, following their specified submission procedures. This may involve mailing the form, submitting it electronically, or delivering it in person.
07
Keep copies of all the documents submitted for your records and for future reference.
Who needs second injury fund surcharge:
01
Employers who have workers' compensation insurance policies and have hired employees with prior disabilities or injuries may be required to pay the second injury fund surcharge.
02
This surcharge is typically applicable when a new injury occurs to an employee who already has a pre-existing disability or injury, and the employer's insurance policy covers both the new and pre-existing conditions.
03
The purpose of the second injury fund surcharge is to ensure that the cost of providing workers' compensation benefits to employees with pre-existing conditions is distributed among multiple employers, rather than solely borne by the employer where the new injury occurred.
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What is second injury fund surcharge?
The second injury fund surcharge is a fee assessed on employers to help fund benefits for workers who are injured on the job and have a pre-existing condition.
Who is required to file second injury fund surcharge?
Employers who have employees that are eligible for workers' compensation are required to file second injury fund surcharge.
How to fill out second injury fund surcharge?
To fill out the second injury fund surcharge, employers need to provide information about their employees, payroll, and any previous workers' compensation claims.
What is the purpose of second injury fund surcharge?
The purpose of the second injury fund surcharge is to ensure that workers who are injured on the job are able to receive the benefits they need, even if they have a pre-existing condition.
What information must be reported on second injury fund surcharge?
Employers must report information about their employees, payroll, and any previous workers' compensation claims on the second injury fund surcharge.
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