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This form is used by employees of the Lafayette Parish School Board to elect their choice of workers’ compensation benefits and retirement contributions during their absence from work due to a work-related
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How to fill out workers compensation selector form
How to fill out Workers’ Compensation Selector Form
01
Begin with your personal information: enter your name, address, and phone number.
02
Provide your employer's information: fill in the employer's name, address, and contact details.
03
Describe the nature of your injury or illness: include details about how and when it occurred.
04
Specify the date of the incident: mention the exact date when the incident took place.
05
Indicate the type of work you were doing at the time of the incident: provide a brief description of your job duties.
06
List any witnesses: include names and contact information of anyone who witnessed the incident.
07
Review the form for accuracy: ensure all information is correct before submission.
08
Submit the form to the appropriate worker's compensation office or your HR department.
Who needs Workers’ Compensation Selector Form?
01
Employees who have been injured or become ill due to their work-related duties.
02
Employers who need to document work-related injuries for compensation purposes.
03
Insurance providers processing claims related to workplace injuries.
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What is Workers’ Compensation Selector Form?
The Workers’ Compensation Selector Form is a document used by employers to determine and indicate their choice of workers' compensation coverage options.
Who is required to file Workers’ Compensation Selector Form?
Employers who are required to provide workers' compensation insurance coverage for their employees must file the Workers’ Compensation Selector Form.
How to fill out Workers’ Compensation Selector Form?
To fill out the Workers’ Compensation Selector Form, employers should provide the necessary information regarding their business, the type of coverage selected, and ensure all sections are completed accurately and signed.
What is the purpose of Workers’ Compensation Selector Form?
The purpose of the Workers’ Compensation Selector Form is to allow employers to officially select their workers' compensation coverage while complying with state regulations.
What information must be reported on Workers’ Compensation Selector Form?
The information that must be reported includes the employer's business name, address, type of business, number of employees, and the chosen type of workers' compensation insurance coverage.
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