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Capitol Administrators, Inc., P.O. Box 2318 Rancho Cordova, CA 957412318 For Information call (800) 3315301 SUBMIT ALL CLAIM TO: IMPORTANT INSTRUCTIONS USE A SEPARATE CLAIM FORM FOR EACH MEMBER OF
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What is use a separate claim?
A separate claim is used to request compensation or benefits for a specific incident or injury that is not covered under a previous claim.
Who is required to file use a separate claim?
Any individual who has suffered a new incident or injury that is not covered under a previous claim is required to file a separate claim.
How to fill out use a separate claim?
To fill out a separate claim, you must provide detailed information about the new incident or injury, including dates, locations, and any supporting documentation.
What is the purpose of use a separate claim?
The purpose of a separate claim is to ensure that individuals receive compensation or benefits for new incidents or injuries that are not covered under existing claims.
What information must be reported on use a separate claim?
Information that must be reported on a separate claim includes details of the new incident or injury, dates, locations, and any supporting documentation.
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