Get the free Bwc Subrogation Referral Form

This form is used to refer cases involving subrogation claims related to personal injury accidents. It collects essential information about the claimant, the accident, and involved parties for processing by the Subrogation Department.

How to fill out bwc subrogation referral form

How to fill out bwc subrogation referral form

1. Obtain the BWC Subrogation Referral Form from the official BWC website or your local office.
2. Fill in the claimant’s information including name, address, and claim number.
3. Provide details of the injury or illness that prompted the claim, including date and description.
4. Include information about the liable third party, if applicable, detailing their involvement in the incident.
5. Attach any necessary supporting documents, such as police reports or medical records.
6. Review the completed form for accuracy and completeness.
7. Submit the form to the appropriate BWC office via mail or electronically as instructed.

Who needs bwc subrogation referral form?

1. Individuals who have filed a workers' compensation claim involving a third party.
2. Employers who are seeking to recoup costs related to a worker's injury from a liable third party.
3. Legal representatives handling workers' compensation cases involving subrogation.

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What is bwc subrogation referral form?

The BWC subrogation referral form is a document used by employers to notify the Bureau of Workers' Compensation (BWC) of an injured worker's claim where there may be a third party liable for the injury, allowing the BWC to seek reimbursement for benefits paid to the injured worker.

Who is required to file bwc subrogation referral form?

Employers who have filed a workers' compensation claim for an employee and believe that a third party may be liable for the injury are required to file the BWC subrogation referral form.

How to fill out bwc subrogation referral form?

To fill out the BWC subrogation referral form, employers must provide detailed information including the employee's claim number, descriptions of the incident, information about any third parties involved, and any documentation supporting the subrogation claim.

What is the purpose of bwc subrogation referral form?

The purpose of the BWC subrogation referral form is to enable the BWC to recover costs associated with workers' compensation claims from third parties that may have contributed to the worker's injury.

What information must be reported on bwc subrogation referral form?

The form requires information such as the employee's name and claim number, details of the incident, a description of the injury, any third party information, and relevant documentation supporting the claim for subrogation.