Get the free WSR WORKERS COMP CLAIM FAX COVERSHEET

W O R L E Y, S C H I L L I N G & R A N D A L L I N S U R A N C E Established 1920 146 N. Fairground Street Marietta, GA 30060 Phone: (770) 4281565Fax: (770) 4268601Worker s Compensation Claim First

How to fill out wsr workers comp claim

How to fill out wsr workers comp claim

1. Step 1: Obtain the necessary forms from your employer or workers' compensation insurance carrier.
2. Step 2: Fill out the employee section of the WSR workers' comp claim form. Provide your personal information, including your name, address, date of birth, and contact details.
3. Step 3: Provide details about the injury or illness you experienced at work. Write down the date, time, and location of the incident. Describe the circumstances surrounding the injury or illness and the body parts affected.
4. Step 4: Include details about any witnesses present at the time of the incident. Provide their names and contact information if available.
5. Step 5: Indicate whether you sought medical treatment for the injury or illness. Provide the name and contact information of the medical provider or facility.
6. Step 6: Attach any supporting documents, such as medical records, accident reports, or witness statements.
7. Step 7: Sign and date the WSR workers' comp claim form.
8. Step 8: Submit the completed form to your employer or workers' compensation insurance carrier as instructed.

Who needs wsr workers comp claim?

1. Employees who sustain work-related injuries or illnesses and wish to seek workers' compensation benefits need to fill out the WSR workers' comp claim form. This includes individuals who work for an employer covered by workers' compensation insurance.

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What is wsr workers comp claim?

WSR workers comp claim is a claim for workers' compensation benefits that is filed by an employee who has been injured on the job.

Who is required to file wsr workers comp claim?

Any employee who is injured on the job and believes they are entitled to workers' compensation benefits is required to file a WSR workers comp claim.

How to fill out wsr workers comp claim?

To fill out a WSR workers comp claim, the employee must provide detailed information about the injury, how it occurred, and any medical treatment received.

What is the purpose of wsr workers comp claim?

The purpose of a WSR workers comp claim is to enable employees who are injured on the job to receive compensation for their injuries, medical expenses, and lost wages.

What information must be reported on wsr workers comp claim?

Information that must be reported on a WSR workers comp claim includes the name of the injured employee, details of the injury, date and time of the injury, and any medical treatment received.