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Reset Print Claim for Compensation by Widow Widower and/or Children U.S. Department of Labor Office of Workers Compensation Programs OMB No. 1240-0013 Expires 07-31-2013 2.

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You must report your injury to your employer within 30 days from the date you were hurt or from the date you knew your injury or illness was related to your job. If you do not let your employer know about your injury within 30 days, you may not get benefits.

“The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability there from and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.”

A worker is said to have a lost-time injury if they are hurt while on the job and, as a result of their injuries, are unable to complete regularly assigned job duties for a minimum of one shift or one full workday.

Gradual onset injuries are when a worker has done the same job, typically for many years. The body wears down and at some point, injuries happen. Outside of work, this is called degenerative and ACC typically does not cover the claim.

As stated in section B. 1 on page 48 of the Recordkeeping Guidelines for Occupational Injuries and Illnesses, lost workday cases involving days away from work are cases resulting in days the employees would have worked but could not because of the work related injury or illness.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232