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FIRST REPORT OF INJURY To report a claim: Call 303.361.4000 or 800.873.7242 Or Fax to 303.361.5000 or 888.329.2251 Or, go to www.pinnacol.com PLEASE PRINT CLEARLYEarly reporting can save you money.
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How to fill out form workers comp claims
How to fill out form workers comp claims
01
Obtain the necessary form for workers comp claims from your employer or the state workers' compensation agency.
02
Carefully read and understand the instructions on the form before filling it out.
03
Provide accurate and detailed information about the injury or illness that occurred at work.
04
Include any relevant medical records or documents to support your claim.
05
Submit the completed form to the appropriate party within the designated time frame.
Who needs form workers comp claims?
01
Employees who have suffered a work-related injury or illness and are seeking compensation for medical expenses and lost wages.
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What is form workers comp claims?
Form workers comp claims are official documents used to report and request compensation for work-related injuries or illnesses under a workers' compensation insurance program.
Who is required to file form workers comp claims?
Employees who suffer work-related injuries or illnesses are required to file form workers comp claims to receive benefits. Employers also play a role in the filing process by providing necessary documentation.
How to fill out form workers comp claims?
To fill out form workers comp claims, employees should provide personal information, details about the injury or illness, the date and time it occurred, and any medical treatment received. Specific forms may vary by state.
What is the purpose of form workers comp claims?
The purpose of form workers comp claims is to ensure that employees can file for benefits covering medical expenses and lost wages due to work-related injuries or illnesses.
What information must be reported on form workers comp claims?
Information that must be reported includes employee details, employer information, a description of the injury or illness, medical information, and any witnesses if applicable.
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