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Get Form 07-6109 - Alaska Department Of Labor And Workforce ... - Labor Alaska

CB Use Only) (Type or Print) This form should be filed only after the employer or the insurer has submitted a Notice of Possible Claim Against the Second Injury Fund (AWCB form 07-6110) and has paid at least 104 weeks in compensation payments. Since regulation 8 AAC 45.186(f) does not allow the Second Injury Fund to make lump-sum reimbursements, reimbursement for compensation between 104 weeks and the filing date of this petition will be made on a monthly basis. Second Injury Fund reimbursement.

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