Search results with tag "Authorization to receive"

Authorization to Receive Workers' Compensation Payment

Authorization to Receive Workers' Compensation Payment Attorney's name Representative ID number Injured worker's name Claim number BWC-1360 (Rev. June 4, 2014) C-230 Temporary total Wage loss Change of occupation Scheduled loss Permanent total disability Death benefits Impairment of earning capacity Violation of specific safety Facial disfigurement

  Payments, Authorization, Compensation, Receive, Authorization to receive, Compensation payment