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Este formulario debe ser completado por el empleado lesionado y el superior oficial en todos los casos en que un empleado esté incapacitado y en un estado de no pago durante más de tres días calendario,
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How to fill out CA-4
01
Download the CA-4 form from the relevant website or obtain a physical copy.
02
Begin filling in your personal information at the top of the form, including your name, address, and contact details.
03
Provide any necessary identification numbers, such as Social Security number or employee ID.
04
Complete the sections detailing your medical history and current condition, being as accurate and thorough as possible.
05
Review the form to ensure all sections are filled correctly, including dates and signatures.
06
Sign and date the form where indicated.
07
Submit the completed CA-4 form through the provided channels, whether by mail, fax, or electronically.
Who needs CA-4?
01
Individuals applying for workers' compensation benefits following an injury or illness incurred while on the job.
02
Employees seeking medical treatment coverage related to a workplace injury.
03
Workers who need to document their injury formally for their employer or insurance provider.
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What is CA-4?
CA-4 is a form used for reporting information related to employee injury claims under California's workers' compensation system.
Who is required to file CA-4?
Employers and employees involved in a work-related injury should file CA-4 to document the incident and seek compensation benefits.
How to fill out CA-4?
To fill out CA-4, provide the necessary details about the injury, including the employee's information, the nature of the injury, the date and location of the incident, and any medical treatment received.
What is the purpose of CA-4?
The purpose of CA-4 is to officially document a worker's injury claim and to ensure that employees receive the benefits they are entitled to under the workers' compensation law.
What information must be reported on CA-4?
The information required on CA-4 includes the injured employee's name, address, date of birth, the date and time of the injury, a description of the injury, and any medical attention received or needed.
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