Get the free Workers Compensation Application ( 130) Transmittal Sheet

Workers Compensation Application (130) Transmittal Sheet Forward new business submissions with this completed form to Michelle St. Angelo at ms tangelo massagent.com or contact her for questions at

How to fill out workers compensation application 130

How to fill out workers compensation application 130

1. To fill out workers compensation application 130, follow these steps:
2. Obtain the workers compensation application 130 form from your employer or download it from the appropriate government website.
3. Read the instructions provided with the application form carefully to understand the requirements and guidelines for filling it out.
4. Start by providing your personal information, including your full name, address, contact details, and social security number.
5. Next, provide details about your employer, such as the company name, address, and contact information.
6. Indicate the date and time of the injury or illness that led to your workers compensation claim.
7. Describe the nature and cause of the injury or illness in detail.
8. Provide information about any medical treatment you have received for the injury or illness.
9. Include the names and contact details of any witnesses who can support your claim.
10. Answer all the additional questions on the application form accurately and truthfully.
11. Review the completed application form to ensure all the information provided is correct and legible.
12. Sign and date the application form.
13. Make a copy of the filled-out application form for your own records.
14. Submit the completed application form to the appropriate authority or your employer as instructed.
15. Keep a copy of any supporting documents you include with the application form.
16. Follow up with the relevant authority or your employer to ensure your application is being processed.
17. Note: It is recommended to consult with a workers compensation attorney or seek legal advice if you have any doubts or need assistance in filling out the application form.

Who needs workers compensation application 130?

1. Workers who have suffered a work-related injury or illness and wish to file a workers compensation claim need to fill out workers compensation application 130. This form is typically required by the employer or the relevant government authority to initiate the claims process and provide necessary information about the incident, injury, and medical treatment received. It is essential for workers seeking compensation benefits to accurately fill out and submit this application form in a timely manner.

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What is workers compensation application 130?

Workers compensation application 130 is a form that is used to apply for workers' compensation benefits in case of a work-related injury or illness.

Who is required to file workers compensation application 130?

Employees who sustain a work-related injury or illness are required to file workers compensation application 130 to apply for workers' compensation benefits.

How to fill out workers compensation application 130?

Workers can fill out workers compensation application 130 by providing detailed information about the injury or illness, along with their personal information and details about their employment.

What is the purpose of workers compensation application 130?

The purpose of workers compensation application 130 is to facilitate the process of applying for and receiving workers' compensation benefits for work-related injuries or illnesses.

What information must be reported on workers compensation application 130?

Workers must report information such as the date of injury or onset of illness, the circumstances surrounding the injury or illness, and any medical treatment received.