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WORKERS' COMPENSATION ADDENDUM (July 2005 Revision) to THE CURRENT COLLECTIVE BARGAINING AGREEMENT between ASSOCIATED GENERAL CONTRACTORS OF CALIFORNIA, INC., ENGINEERING AND UTILITY CONTRACTORS ASSOCIATION,

How to fill out workers39 compensation addendum

How to Fill Out Workers' Compensation Addendum:

1. Begin by obtaining the workers' compensation addendum form. This form is typically provided by your employer or insurance company.
2. Start by filling out the basic information section of the addendum. This includes providing your personal details such as your full name, contact information, social security number, and employee identification number.
3. Next, provide details about the workplace injury or illness that you are filing the workers' compensation claim for. Include the date and time of the incident, a description of what happened, the location where it occurred, and any witnesses present.
4. If you have received medical treatment or visited a healthcare professional related to the injury or illness, provide the name and contact information of the treating physician or medical facility.
5. Indicate whether you have missed or expect to miss any workdays as a result of the injury or illness. Provide the date when you first missed work and specify the anticipated duration of absence.
6. If you have already provided notice to your employer about the incident, indicate the date when you informed them and provide any supporting documentation or communication if required.
7. Finally, sign and date the workers' compensation addendum to certify that the information provided is accurate and complete to the best of your knowledge.

Who needs Workers' Compensation Addendum:

1. Employees who have experienced a work-related injury or illness and are seeking compensation and benefits under their employer's workers' compensation insurance program may need to fill out a workers' compensation addendum.
2. Employers and insurance companies often require injured or ill employees to complete this addendum as part of the claims process. It helps collect detailed information about the incident, ensuring that the claim is properly assessed and processed.
3. The workers' compensation addendum is necessary to substantiate and document the circumstances surrounding the workplace injury or illness. It serves as a crucial tool for both the injured employee and the employer's insurance provider to facilitate a fair and efficient claims resolution process.

For pdfFiller’s FAQs

What is workers' compensation addendum?

Workers' compensation addendum is a document that supplements an existing workers' compensation policy by providing additional details or information.

Who is required to file workers' compensation addendum?

Employers who have a workers' compensation policy in place are required to file the workers' compensation addendum.

How to fill out workers' compensation addendum?

To fill out the workers' compensation addendum, employers must provide information such as employee details, job classifications, payroll information, and any changes to the policy.

What is the purpose of workers' compensation addendum?

The purpose of the workers' compensation addendum is to ensure that all necessary information related to workers' compensation coverage is accurately reported and maintained.

What information must be reported on workers' compensation addendum?

Information such as employee names, job descriptions, wages, and any changes to the policy must be reported on the workers' compensation addendum.

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