Work Status Form (formerly Worker Verification Form)

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Work Status Form (formerly Worker Verification Form)

(265 KB PDF)
Descripción

This form was previously called the Worker Verification Form. This is to be 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.

 

Detalle
Número del formulario F242-052-000
Disponibilidad solicítelo
Palabras claves benefits, claims, coverage, espanol, industrial insurance, occupational injuries, payment, spanish, time loss compensation, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Idiomas English, Spanish
Fechas válidas 11-2014
Contacto Managing Injured Workers' Claims
Páginas de Internet Workers' Comp Claims

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