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NEW HAMPSHIRE WORKERS COMPENSATION MEDICAL FORM This form must be completed at each health professional visit (MD, DO, DC or DDS) and must be filed with the worker s compensation insurance carrier.

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Related content

Forms | Workers' Compensation Division | NH...
The forms listed below are the official New Hampshire State Forms. ... 9-2015); NH...
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The report [PDF] shows a downward trend in employers' overall workers' comp costs. The costs per $100 in covered wages decreased in every state between 2016 and 2020....The highest workers' comp rates by state jurisdiction are: Wyoming: $1.78. Alaska: $1.74. Hawaii: $1.69. Montana: $1.64. South Carolina: $1.55. Idaho: $1.47.

Virginia law requires that most employers carry workers' compensation insurance in order to cover their workers in the event of a work injury. Workers' compensation provides a tradeoff for both employers and employees. For the employer, it provides an exclusive remedy, shielding the employer from civil suit.

Workers' Compensation for New Hampshire Workers. If you are hurt at work, workers' compensation (or "workers' comp") pays your medical bills. It also pays 60% of your lost wages after you miss more than three days of work. Workers' compensation is a type of insurance that all employers MUST provide.

The maximum weekly benefit is adjusted on July 1 of each year.... Date of AccidentWeekly Maximum Total / PartialJuly 1, 2022 - June 30, 2023$1,125.46 / $1,125.46July 1, 2021 - June 30, 2022$1,063.05 / $1,063.05July 1, 2020 - June 30, 2021$966.78 / $966.78July 1, 2019 - June 30, 2020$934.11 / $934.1116 more rows

If you have a work-related injury or illness, your employer is required by law to pay for workers' compensation benefits. You could get hurt by: One event at work, such as hurting your back in a fall, getting burned by a chemical that splashes on your skin or getting hurt in a car accident while making deliveries.

The weekly maximum is $1,255.50, 60% of the injured workers actual average weekly wage or $251.10, if greater, and not to exceed 100% or the injured workers after tax earnings. Maximum period of payments is the length of disability. Note: Non-scheduled injuries have a maximum period of payments of 262 weeks.

New Hampshire Workers' Compensation & First Report of Injury Once you fill out the form, you can: Fax it to: 603-271-6149. Mail it to: Workers' Compensation Division, NH Department of Labor, 95 Pleasant St., Concord, NH 03301. Email it to: WorkersComp@dol.nh.gov.

Workers' compensation systems were established to provide partial medical care and income protection to employees who are injured or become ill from their job. These systems also provide employers incentives to reduce work-related injury and illness.

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© Copyright 1997-2025
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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:
1-877-389-0141
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