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TEST INSURER 2 C/O TEST INSURER 2 RM C100 201 E WASHINGTON AVE MADISON WI 53703WC CLAIM NO: INJURY DATE: EMPLOYEE: EMPLOYER: INSURER NO:9999999999 IF YOU CALL OR WRITE US 05/01/85 PLEASE USE WC CLAIM
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The wc86f additional information form is typically needed by individuals who have filed a workers' compensation claim and are requested to provide further details or evidence related to their case.
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The wc86f additional information is a form used to provide further details or clarifications on a workers' compensation claim.
The injured worker, employer, or insurance company may be required to file wc86f additional information.
The wc86f additional information form should be filled out accurately and completely with all relevant details regarding the workers' compensation claim.
The purpose of wc86f additional information is to ensure all necessary information is provided to accurately assess and process a workers' compensation claim.
The information reported on the wc86f additional information form may include details on the injury, medical treatment, work restrictions, and any additional pertinent information.
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