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Attorney or Party without Attorney: Telephone No: PHOTOCOPY WORK ORDER R. C. NIXON 800.628.6614 NIXON, MITCHEL, SPENCE & KORNBERG 123 LEGAL WAY CarmelbytheSea, CA. 93921 Attorney for:Defendant, Santa

How to fill out pc wcab sub

To fill out a PC WCAB Sub, follow these steps:

1. Begin by gathering all the necessary information to complete the form, such as the parties involved, case details, and any relevant documents.
2. Start filling out the form by providing the correct contact information for the person submitting the form, including their name, address, phone number, and email.
3. Proceed to enter the details of the injured worker, including their name, address, phone number, and any other pertinent information.
4. Indicate the date of injury and the specific body part(s) affected in the appropriate sections.
5. If applicable, provide the name and contact information of the employer or insurance company representing the employer.
6. Describe the injury and any related medical treatment in detail, including the diagnosis, relevant medical providers, and the steps taken to address the injury.
7. If there are any witnesses to the incident, include their names and contact information in the designated section.
8. Next, outline the benefits being requested, such as medical treatment, temporary disability, or permanent disability.
9. Make sure to sign and date the form, certifying the accuracy of the information provided.

Who needs a PC WCAB Sub?

1. Injured workers who want to file a workers' compensation claim in California's Workers' Compensation Appeals Board (WCAB) system need to submit a PC WCAB Sub.
2. Employers or insurance companies representing employers may also need to complete this form when responding to a workers' compensation claim.
3. Attorneys, paralegals, or legal professionals involved in workers' compensation cases often handle the completion of the PC WCAB Sub on behalf of their clients.

Remember, it is crucial to consult with an attorney or legal expert familiar with workers' compensation laws in your jurisdiction to ensure accurate completion of the PC WCAB Sub.

For pdfFiller’s FAQs

What is pc wcab sub?

PC WCAB Sub stands for Pre-Designation of Physician and is a form used to designate a personal physician in case of a work-related injury.

Who is required to file pc wcab sub?

All employers in California are required to provide the PC WCAB Sub form to their employees.

How to fill out pc wcab sub?

The PC WCAB Sub form can be filled out by the employee by naming their personal physician as their primary treating physician in case of a work-related injury.

What is the purpose of pc wcab sub?

The purpose of PC WCAB Sub is to ensure that an injured employee is able to receive treatment from their chosen personal physician.

What information must be reported on pc wcab sub?

The PC WCAB Sub form must include the employee's personal physician's name, address, and contact information.

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