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Es in MM/DD/YYYY format. 0 1 DO NOT USE THIS SPACE This form must be provided to the employee. (Minn. Rules 5221.0410,l subd. 6) NOTICE TO EMPLOYEE: YOU MUST PROMPTLY PROVIDE A COPY OF THIS REPORT TO YOUR EMPLOYER OR WORKERS COMPENSATION INSURER, AND QUALIFIED REHABILITATION CONSULTANT IF YOU HAVE ONE. WID or SSN DATE OF INJURY EMPLOYEE EMPLOYER INSURER/SELF-INSURER-TPA INSURER CLAIM NUMBER Date of most recent examination by this office Select the appropriate option(s) below and fill.

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The Minnesota Workers Compensation Laws represent a trade-off of sorts for the employee: the employee is guaranteed compensation for any employment-related injury regardless of fault; but the nature and extent of benefits is limited to that provided by the Act.

Workers' Comp Exemptions in Minnesota For Sole Proprietors, Partners, Corporate Officers and LLC Members wishing to be included for coverage, they must be included at an annual wage of no less than $57,824 and no more than $231,296.

What is mandatory coverage? The Minnesota Workers' Compensation Law states that all employers are required to purchase workers' compensation insurance or become self-insured. This is often referred to as "mandatory coverage."

The maximum time frame for temporary total disability benefits is 130 weeks. Compensation time depends on your injury, but you may be able to predict the results by consulting with your doctor regarding healing time and any rehabilitation time.

ing to Minnesota state law, every employer must get workers' compensation coverage. There are few exceptions to this law. Employers in Minnesota are the ones that purchase workers' compensation insurance. Most businesses can buy coverage through private insurance companies, like The Hartford.

Sole proprietorships: A sole proprietor is excluded. The sole proprietor's immediate family members (spouse, parents and children, regardless of age) are also excluded. 2. Partnerships: Partners in business and partners in farm operations are excluded.

Once you have reported your injury, your employer must complete and file a form (a "First Report of Injury" form) with its insurance company and send a copy to you. The insurance company must file a report with the Minnesota Department of Labor & Industry (MDLI) within ten days.

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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