Get the free WORKERS COMPENSATION CLAIM FORM 2B REG 6AA

WORKERS COMPENSATION CLAIM FORM 2B (REG 6AA) SECTION 84(1)(b) OF THE WORKERS COMPENSATION AND REHABILITATION ACT 1981 Employer please give this fact sheet to the injured worker TO THE INJURED WORKER:

How to fill out workers compensation claim form

How to fill out a workers compensation claim form:

1. Obtain the necessary forms: Contact your employer's human resources department or workers compensation insurance carrier to get the appropriate claim forms. They may be available online or in paper format.
2. Fill in personal information: Begin by providing your full name, address, phone number, and email address. Include your job title and the date of the accident or injury.
3. Describe the incident: Explain how and where the accident occurred in detail. Include specific dates, times, and any witnesses present. Be as specific as possible, providing accurate and concise information.
4. Detail the injury: Describe your injury or medical condition resulting from the accident. Include the body parts affected, symptoms experienced, and any medical treatments received.
5. Provide medical information: Write down the names and contact information of any medical providers you have seen related to the injury. Include the names of hospitals, doctors, therapists, and any specialists involved in your treatment.
6. Include employment details: Provide information on your employment, such as your start date, job duties, and salary. Attach any relevant employment documents, such as pay stubs or contracts.
7. Attach supporting documents: Collect any supporting paperwork related to the accident or injury, such as accident reports, medical records, witness statements, or photographs. Make copies of these documents and attach them to your claim form.
8. Sign and date the form: Review the completed form for accuracy and sign and date it. Keep a copy for your records before submitting it to your employer or the appropriate workers compensation department.

Who needs a workers compensation claim form:

1. Employees who have suffered a work-related injury or illness: Any employee who has been injured or fallen ill while performing their job duties should complete a workers compensation claim form. This includes both temporary and permanent employees, regardless of their full-time or part-time status.
2. Independent contractors: Depending on the jurisdiction and specific circumstances, independent contractors may also be eligible for workers compensation benefits. It is recommended that they consult with their employer or legal counsel to determine if they are covered and need to submit a claim.
3. Family members of deceased employees: In the unfortunate event of a work-related fatality, the surviving family members may be entitled to workers compensation benefits. They should complete a claim form to initiate the process of receiving any applicable benefits.

For pdfFiller’s FAQs

What is workers compensation claim form?

Workers compensation claim form is a document used to report an injury or illness that occurred in the workplace.

Who is required to file workers compensation claim form?

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

How to fill out workers compensation claim form?

To fill out a workers compensation claim form, the employee needs to provide personal information, details of the injury or illness, and any relevant medical documentation.

What is the purpose of workers compensation claim form?

The purpose of a workers compensation claim form is to initiate the process of receiving compensation for a work-related injury or illness.

What information must be reported on workers compensation claim form?

Information such as the employee's personal details, the date and time of the injury, the circumstances of the injury, and any medical treatment received must be reported on workers compensation claim form.

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