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Carpenters Health and Security Trust of Western Washington PO Box 1929 Seattle, Washington 98111 (206) 441-6514 Time Loss Application Employed Carpenters 1. 2. You (the carpenter) must complete Section
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How to fill out time loss application
How to fill out time loss application:
01
Start by gathering all necessary information: Make sure to have your personal details, including your name, contact information, and social security number, readily available. Additionally, make note of the date and time you experienced the injury or illness that resulted in time loss.
02
Provide details about your employer: In the application, include the name, address, and contact information of your employer. You may also be required to provide specific details about your job position and duties.
03
Describe the injury or illness: Clearly explain the nature of your injury or illness. Provide specific details about how it occurred, where it happened, and any contributing factors. Be sure to accurately convey the impact it has had on your ability to work and any medical treatment you have received or will require.
04
Include medical documentation: Attach any relevant medical documents or records that support your claim. These may include doctors' notes, test results, or hospital discharge papers. It is crucial to provide thorough and accurate medical documentation to strengthen your application.
05
Complete the time loss section: Fill out the section that pertains to your time loss, which typically asks for information on the dates you were unable to work due to the injury or illness. Indicate whether you have received any compensation or insurance benefits during this time.
Who needs time loss application:
01
Employees who have experienced an injury on the job: If you sustained an injury while performing your job duties, it is likely that you will need to fill out a time loss application. This application serves as a way for you to report the injury and request compensation for any time away from work.
02
Workers with an occupational illness: Individuals who develop an illness as a direct result of their work environment or job duties may also need to complete a time loss application. This applies to conditions such as repetitive strain injuries, respiratory illnesses, or exposure to toxic substances.
03
Employees seeking temporary disability benefits: If you are unable to work due to a non-work-related injury or illness and are covered by an insurance policy or program that provides temporary disability benefits, you may be required to fill out a time loss application to claim these benefits.
Remember, it is important to consult with your employer or the relevant authorities to ensure you follow the correct procedures and provide all necessary information when filling out a time loss application.
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What is time loss application?
Time loss application is a form used to request compensation for lost wages due to work-related injuries or illnesses.
Who is required to file time loss application?
Employees who are unable to work due to a work-related injury or illness are required to file a time loss application.
How to fill out time loss application?
Time loss applications can be filled out online, by mail, or in person at the workers' compensation office. The application requires information about the employee, their employer, the injury/illness, and the lost wages.
What is the purpose of time loss application?
The purpose of a time loss application is to request compensation for lost wages that resulted from a work-related injury or illness.
What information must be reported on time loss application?
Information such as the employee's name, employer's name, date of injury/illness, details of the injury/illness, and documentation of lost wages must be reported on a time loss application.
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