Worker S Injury Claim Form
Found 5 free book(s)Injured Worker Guidebook - California Department of ...
www.dir.ca.govI m afraid I might be fired because of my injury. Can my employer fire me? 8. Besides workers compensation benefits, can I get any other financial assistance? 8. Keep your claim on track 9. Chapter 3. Medical Care 10. What happens after I file the claim form? 6. Can I switch to a different doctor for treatment? 13
Workers’ Compensation Claim Form (DWC 1) & Notice of ...
www.dir.ca.govTo file a claim, complete the “Employee” section of the form, keep one copy and give the rest to your employer. Do this right away to avoid problems with your claim. In some cases, benefits will not start until you inform your employer about your injury by filing a …
First Report of Injury - Virginia
workcomp.virginia.govEmployer’s Mailing Address Name/FEIN of Entity on Policy Nature of Business Name and Address of Insurer or Self-Insurer for this Claim Policy Number Time and Place of Accident Location where accident occurred Date of injury Hour of injury a.m. p.m. If fatal, give date of death Date injury or illness reported
STATE OF CALIFORNIA DIVISION OF WORKERS' …
www.dir.ca.govTherefore, if the injury did not occur at a fixed or identifiable location (such as a field, a highway,or on water), or if the injury occurred outside of the United States, the employer's business address or another appropriate address must be specified; however, a short explanation regarding the place of injury may be appended to the application.
Injury Compensation for Federal Employees Publication CA-810
www.dol.govThe FECA (5 U.S.C. 8101 et seq.) provides compensation benefits to civilian employees of the United States for disability due to personal injury or disease sustained while in the performance of duty. The FECA also provides for payment of benefits to dependents if a work-related injury or disease causes an employee’s death. The FECA is intended to
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Worker, Injury, Claim, Claim Form, Form