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APPLICATION FOR SICK OR INJURY BENEFITS (RETIRED) PLEASE USE BLUE INK PEN / FAX (323) 2595223 or (323) 2595222 MEMBER INFORMATION FULL ASOCIAL SECURITY NUMBERADDRESSBIRTH DATECITYHOME PHOTOCELL PHONETODAYS
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How to fill out sick or injury benefits

01
Obtain the necessary forms for filing sick or injury benefits from your employer or the relevant government agency.
02
Fill out your personal information accurately, including your full name, address, contact details, and Social Security number.
03
Provide details about your illness or injury, including the date it occurred, how it happened, and any medical treatments you have received or are currently undergoing.
04
Include any supporting documentation, such as medical records, doctor's notes, or proof of hospitalization, to substantiate your claim.
05
Double-check all the information filled in to ensure accuracy and completeness.
06
Submit the completed form along with the supporting documents to your employer or the relevant government agency as per their instructions.
07
Follow up on the status of your claim regularly and provide any additional information or documentation if requested.
08
Keep copies of all submitted documents for your records.

Who needs sick or injury benefits?

01
Sick or injury benefits are generally needed by individuals who are unable to work due to illness or injury.
02
This includes employees who have sustained work-related injuries, individuals with temporary or long-term disabilities, and those with contagious illnesses.
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Sick or injury benefits are financial payments provided to individuals who are unable to work due to a medical condition or injury. These benefits aim to help support them during their recovery period.
Typically, employees who are entitled to receive sick or injury benefits from their employer or under a government program are required to file for these benefits.
To fill out sick or injury benefits, individuals should obtain the appropriate forms, provide necessary medical documentation, detail their employment information, and submit the completed forms to their employer or the relevant insurance provider.
The purpose of sick or injury benefits is to provide financial support to individuals who are temporarily unable to work due to a health issue, helping them manage their expenses during recovery.
Information that must be reported includes the employee's personal details, the nature of the illness or injury, the dates of disability, medical documentation, and details regarding employment and income.
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