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INSTRUCTIONS Theformmustbecompletedbysomeoneotherthantheinjuredemployee whoisanauthorizedrepresentativecapableofobtainingpersonnel informationabouttheinjuredemployeeandhasreceivedadescriptionof theaccidentoreventreportedasthecauseofinjury.

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How to fill out 01 workers comp claim

01

Obtain the 01 workers comp claim form from your employer or workers' compensation insurance provider.

02

Fill out your personal information such as name, address, and contact details.

03

Provide details about the injury or illness you are seeking compensation for, including how and where it occurred.

04

Include information about any medical treatment you have received or are receiving for the injury or illness.

05

Sign and date the form before submitting it to your employer or workers' compensation insurance provider.

Who needs 01 workers comp claim?

01

Employees who have suffered a work-related injury or illness and are seeking compensation for medical expenses, lost wages, or disability benefits.

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What is 01 workers comp claim?

01 workers comp claim is a form submitted by an employee who has been injured or becomes ill due to work-related activities in order to request compensation for medical expenses and lost wages.

Who is required to file 01 workers comp claim?

Any employee who has been injured or become ill due to work-related activities is required to file a 01 workers comp claim.

How to fill out 01 workers comp claim?

To fill out a 01 workers comp claim, the employee must provide details about the injury or illness, medical treatment received, and any time missed from work.

What is the purpose of 01 workers comp claim?

The purpose of 01 workers comp claim is to request compensation for medical expenses and lost wages incurred as a result of a work-related injury or illness.

What information must be reported on 01 workers comp claim?

Information that must be reported on a 01 workers comp claim includes details of the injury or illness, medical treatment received, and any time missed from work.

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