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APPEAL NO. 121814 FILED DECEMBER 10, 2012 This appeal arises pursuant to the Texas Workers Compensation Act, TEX. LAB. CODE ANN. 401.001 et seq. (1989 Act). A contested case hearing was held on August
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How to fill out a-3 - workers compensation

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Obtain the A-3 form from your employer or workers' compensation insurance provider.
02
Fill out your personal information, including your name, address, and contact details.
03
Provide details of your employer, including their name and address.
04
Describe the nature of your injury or illness that occurred at work.
05
Include the date and time of the accident or when the injury first manifested.
06
Sign and date the form before submitting it to the appropriate party.

Who needs a-3 - workers compensation?

01
Employees who have sustained a work-related injury or illness and are seeking compensation for medical treatment, lost wages, or disability benefits.
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The A-3 form for workers' compensation is a report used by employers to provide details about workplace injuries or illnesses that occur to employees while on the job.
Employers who have employees that experience work-related injuries or illnesses are required to file the A-3 form for workers' compensation.
To fill out the A-3 form, employers must provide information about the employee, details of the injury or illness, how it occurred, and medical treatment provided, as well as sign the form.
The purpose of the A-3 form is to document workplace injuries or illnesses, ensuring that employees receive appropriate benefits and that employers comply with reporting obligations.
The A-3 form must report the employee's name, date of injury, nature of the injury, circumstances leading to the injury, and any medical treatment received.
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