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FOR COMMISSION USE ONLY CCFORM2A OKLAHOMA WORKERS COMPENSATION COMMISSION 1915 NORTH STILES AVENUE Send original to: OKLAHOMA CITY, OKLAHOMA 73105 Workers Compensation Commission and 1 copy to Employee
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How to fill out cc-form-2a oklahoma workers39 compensation

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How to Fill Out CC-Form-2A Oklahoma Workers' Compensation:

01
Start by obtaining a copy of the CC-Form-2A, which is the official form for reporting Oklahoma Workers' Compensation claims.
02
On the top of the form, fill in your personal information, such as your full name, address, phone number, and email address.
03
Provide the details about your employer, including their name, address, and contact information.
04
Indicate the date of the injury or illness that resulted in the workers' compensation claim.
05
Describe the incident in detail, explaining how it occurred and what injuries or illnesses were sustained. Be as specific as possible and include any contributing factors or witnesses, if applicable.
06
If you have already received medical treatment related to the injury or illness, provide the details of the healthcare provider, including their name, address, and phone number.
07
Fill in the section related to lost wages due to the injury or illness. Include the date you were first unable to work, the amount of time missed, and any wages or benefits you have received as a result.
08
If you have any dependents, provide their names and relationship to you, as well as any financial support they may be entitled to due to your workers' compensation claim.
09
Sign and date the form at the bottom to indicate your understanding and consent.
10
Make a copy of the completed form for your records before submitting it to the appropriate Workers' Compensation agency or your employer's designated representative.

Who Needs CC-Form-2A Oklahoma Workers' Compensation?

01
Employees who have sustained a work-related injury or illness in the state of Oklahoma.
02
Employers who are required to report workers' compensation claims to the appropriate agency.
03
Healthcare providers who have provided treatment to individuals with work-related injuries or illnesses and need to provide information for the workers' compensation process.
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cc-form-2a is a form used in Oklahoma for reporting workers' compensation information.
Employers in Oklahoma are required to file cc-form-2a for workers' compensation.
You can fill out cc-form-2a by providing information about your employees, their job duties, and any work-related injuries.
The purpose of cc-form-2a is to track workers' compensation claims and ensure that employees receive the benefits they are entitled to.
Information such as employee details, injury details, medical treatment received, and any benefits paid must be reported on cc-form-2a.
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1915 OKLAHOMA insurer CONTROVERT 85A OBA false controversion TTD omits controverting abets PPD artifice therefor XX foregoing Typewritten conceals Dependents applicable Indemnity Beneficiaries Amended CERTIFICATION pursuant certify willfully employs suppl

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