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Second Injury Fund Information Review Case Name:Claim Petition Number(s): Wage: Rate: DOB:Last Day of Work: Last Day on Payroll (if different): IF Accidental of Accident: Injuries to:IF Exposures
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Second injury fund information refers to the documentation and reporting required for employers to participate in state-administered funds that provide benefits to workers who suffer a second injury.
Employers who have employees that may qualify for benefits under the second injury fund program are required to file this information.
Employers can fill out the second injury fund information by providing details about the employee, their first injury, second injury, and any other relevant information required by the state program.
The purpose of second injury fund information is to ensure that employees who suffer from multiple workplace injuries are provided with the necessary benefits and compensations.
Employers must report details about the employee, their injuries, previous claims, and any other information required by the state program.
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