Worker Verification Form

Worker Verification Form - (Forms/Publications)
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Title Worker Verification Form (A fillable form - 133 KB PDF)

Completed by the injured worker if they are unable to work due to a workplace injury AND their employer is not paying their full wages.


Form number F242-052-000
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Keywords benefits, claims, coverage, espanol, industrial insurance, occupational injuries, payment, spanish, time loss compensation, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 10-2008
Contact information Managing Injured Workers' Claims
Web pages Workers' Comp Claims

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