Get a Form or Publication: claim closure
Your search for "claim closure" returned 16 documents.
See also
| Title | Type | Number |
|---|---|---|
| Application to Reopen Claim due to Worsening Condition - Spanish Aplicación para Reabrir un Reclamo Debido al Empeoramiento de la Condición
Also available in: English, English/Spanish Spanish version. Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days. |
Form | F242-079-999 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-NTL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-999 |
| Notificación de Decisión de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-TL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-999 |
| Notificación de Decisión de Cierre para reclamos de Tiempo Perdido para Empleadores Autoasegurados
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-999 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-111 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Cambodian
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-666 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Korean
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL - Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL -Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL - Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL -Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-000 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice - Korean
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice -Cambodian
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-666 |
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