Workers compensation election rejection form insured

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WORKERS’ COMPENSATION ELECTION / …

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HORIZON/FORMS/WCELECT(8-96) WORKERS’ COMPENSATION ELECTION / REJECTION FORM INSURED: POLICY #: TERM: TO: In accordance with Chapter 176 of the Minnesota Workers’ Compensation Law, the following persons have the option of …

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WORKERS’ COMPENSATION ELECTION /, WORKERS’ COMPENSATION ELECTION / REJECTION FORM INSURED, Workers, Compensation