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WAS Workers Compensation Claim File Processing Checklist INJURED WORKER INFORMATION Name: ___Job Classification:___ Job Code ___ Home Phone #:___ Supervisor: ___ Employee ID#:___ Employee Address:___

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How to fill out das workers compensation claim

01

Obtain a copy of the DAS Workers Compensation Claim form from your employer or their insurance provider.

02

Fill out all sections of the form, including details about the injury or illness, how it occurred, and any medical treatment received.

03

Make sure to provide any supporting documentation, such as medical records or witness statements, to strengthen your claim.

04

Once completed, submit the form to your employer or their insurance provider within the specified deadline.

05

Keep copies of all paperwork for your own records and follow up with the insurance provider for updates on your claim.

Who needs das workers compensation claim?

01

Employees who have suffered a work-related injury or illness

02

Employees whose employer is covered by workers' compensation insurance

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What is das workers compensation claim?

Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue their employer for negligence.

Who is required to file das workers compensation claim?

Employees who are injured at work and their employers are required to file a workers' compensation claim.

How to fill out das workers compensation claim?

To fill out a workers' compensation claim, the injured employee or their representative must provide details about the injury, how it occurred, and any medical treatment received.

What is the purpose of das workers compensation claim?

The purpose of a workers' compensation claim is to provide financial and medical assistance to employees who are injured on the job.

What information must be reported on das workers compensation claim?

Information such as the date of the injury, how it occurred, the extent of the injury, and any medical treatment received must be reported on a workers' compensation claim.

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