Supplementary Report On Accidents And Industrial Diseases Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Supplementary Report On Accidents And Industrial Diseases Form. This is a Wisconsin form and can be use in Workers Comp.
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Insurer222s Claim Handling Address Salary Cont222d Worker222s Compensation Division American LegalNet, Inc. www.FormsWorkFlow.com employee222s return to work, provide an explanation to the department and the employee. The insurer shall advise the employee for stopping payments, what the employee must do to reinstate payments, and the worker222s rights to a hearing. 13 within 30 days of when final payment of any type of compensation has been made. A practitioner222s report is not that of the treating practitioner, a treating practitioner222s report is necessary if temporary disability exceeds 3 weeks 13 report and the final practitioner222s report must be sent to the employee. All correspondence regarding this injury will be mailed to the insurer222s designated claims handling address.If payments are suspended for any reason other than return to work, state the reason. Explain unusual circumstances under 223oremarks.224 If benefits are denied, be sure to include a copy of the denial letter to the worker. Enter the date the final mediractitioner222s report is icate the payment type under 223other224.226 Salary Cont222d American LegalNet, Inc. www.FormsWorkFlow.com