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WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS EMPLOYER (NAME & ADDRESS INCL ZIP) CARRIER / ADMINISTRATOR CLAIM NUMBER JURISDICTION G E N E R A L EMPLOYER'S LOCATION ADDRESS (IF DIFFERENT)
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Employers in Maryland who are required by law to carry worker's compensation insurance.
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Maryland - wcpolicycom is a form used for filing workers' compensation insurance coverage in the state of Maryland.
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