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MWCC WORKERS COMPENSATION FIRST REPORT OF INJURY OR ILLNESS EMPLOYER (NAME & ADDRESS INCL ZIP)CARRIER/ADMINISTRATOR CLAIM NUMBEREnter Actual School Location HereJURISDICTIONREPORT PURPOSE CODEJURISDICTION CLAIM NUMBERINSURED REPORT NUMBEREMPLOYERS LOCATION ADDRESS (IF DIFFERENT) SIC CODEN/ALOCATION # PHONE #EMPLOYER FEINN/ACARRIER/CLAIMS ADMINISTRATOR CARRIER (NAME, ADDRESS & PHONE NO)POLICY PERIODMississippi School Boards Workers\' Compensation Trust P.O. Box
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How to fill out mwcc - workers039 compensation
How to fill out mwcc - workers039 compensation
01
Obtain the MWCC form from your employer or the appropriate state website.
02
Fill in your personal information, including your name, address, and contact details.
03
Provide the details of your employer, including their name, address, and contact information.
04
Describe the nature of your injury or illness, including the date it occurred and any relevant medical information.
05
Sign and date the form to certify that the information provided is accurate.
06
Submit the completed form to your employer or the workers' compensation board as instructed.
Who needs mwcc - workers039 compensation?
01
Workers who have been injured on the job or have developed an occupational illness.
02
Employees in industries that are required by law to carry workers' compensation insurance.
03
Individuals seeking wage replacement and medical benefits due to work-related injuries.
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What is mwcc - workers039 compensation?
MWCC stands for Maine Workers' Compensation Commission, which oversees the workers' compensation system in the state of Maine. It provides benefits to employees who are injured on the job.
Who is required to file mwcc - workers039 compensation?
Employers in Maine with more than a certain number of employees are required to file for workers' compensation coverage to protect their workers in case of job-related injuries.
How to fill out mwcc - workers039 compensation?
To fill out the MWCC workers' compensation forms, employers need to provide information about the employee, the nature of the injury, the circumstances surrounding it, and any relevant medical information.
What is the purpose of mwcc - workers039 compensation?
The purpose of MWCC workers' compensation is to provide financial and medical benefits to employees who suffer work-related injuries, ensuring they receive the necessary support during recovery.
What information must be reported on mwcc - workers039 compensation?
The information that must be reported includes the employee's details, the description and date of the injury, the employer's information, and any medical treatment provided.
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