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60-day Initial WAS Workers Compensation Selective Duty Form 30-day Extension PER WC 146 / Revised 2008 INSTRUCTIONS: 1. Complete all sections below. 2. Send this form and a copy of the PER-WC 208
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How to fill out das workers39 compensation selective
How to fill out DAS workers' compensation selective:
01
First, gather all necessary information such as the injured worker's personal details (name, address, contact information), the date and time of the accident, and a description of how the injury occurred.
02
Next, fill out the employer section which includes the company name, address, and contact information. Provide the employer's workers' compensation insurance policy details if available.
03
Proceed to the medical section and provide information about the treating physician or medical facility. This includes their name, address, and any other relevant details regarding the medical treatment received by the injured worker.
04
In the wage section, document the injured worker's gross earnings for the period preceding the injury. Include details about the payment frequency (weekly, bi-weekly, monthly) and any other forms of compensation, such as bonuses or commissions.
05
If an attorney is involved, provide their details in the attorney section, including their name, address, and contact information.
06
Lastly, review the completed form for accuracy and make any necessary corrections before submitting it to the appropriate workers' compensation authority.
Who needs DAS workers' compensation selective?
01
Employers who offer workers' compensation coverage to their employees typically need DAS workers' compensation selective. It helps them ensure that the injured worker's information is correctly documented and processed to initiate the insurance claim.
02
Injured workers who have experienced a work-related injury and are seeking compensation through their employer's workers' compensation insurance may need to fill out DAS workers' compensation selective. This form allows them to provide all the required details about their injury and the resulting medical treatment.
03
Medical providers who have treated an injured worker and need to submit the necessary information to the workers' compensation insurance carrier may require DAS workers' compensation selective. This form helps them provide accurate details about the patient's condition, treatment, and related expenses.
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What is das workers39 compensation selective?
The workers' compensation selective is a form used to report information about workers' compensation coverage.
Who is required to file das workers39 compensation selective?
Employers are required to file the workers' compensation selective.
How to fill out das workers39 compensation selective?
The form can be filled out electronically or by hand, providing all necessary information requested.
What is the purpose of das workers39 compensation selective?
The purpose of the form is to ensure that employers have proper workers' compensation coverage for their employees.
What information must be reported on das workers39 compensation selective?
Information such as the employer's name, address, policy number, coverage dates, and carrier information must be reported on the form.
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