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How to fill out the Dwc Ad Form 1013353sjdb online
The Dwc Ad Form 1013353sjdb is essential for documenting offers of modified or alternative work following a workplace injury in California. This guide provides clear, step-by-step instructions to help you effectively fill out the form online.
Follow the steps to complete the Dwc Ad Form 1013353sjdb online.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- In the section completed by the claims administrator, fill in the appropriate claims administrator type (e.g., Third Party Administrator, Insurance Company, Employer). Provide the employer's name, the employee's name, and the job position being offered.
- Enter the date of the job offer and the date the job is set to start using the MM/DD/YYYY format. Include the claims administrator's contact information and claim number.
- Complete the notice to employee section by providing the employee's name, the type of injury, and specific dates of injury. Enter the date the offer was received and the employee's date of birth.
- Review the notice to employee instructions regarding the acceptance or rejection of the job offer, including information about permanent disability payments and eligibility for supplemental job displacement benefits.
- Fill out the position requirements section, including the actual job title, wages, and duration of the job, answering questions regarding salary and job security.
- Describe the location of the work and outline any duties associated with the position, including any physical requirements or modifications supported by a doctor.
- If the employee accepts or rejects the offer in the section to be completed by employee, ensure they provide their signature and date the response. Additionally, state any reasons for rejecting the offer if applicable.
- Finally, review the notice to the parties section for required actions and deadlines, ensuring the completed form is forwarded to the Administrative Director as necessary.
- Once all sections are filled, save changes, download, or print the completed form for your records.
Start filling out your Dwc Ad Form 1013353sjdb online today to ensure prompt and accurate processing.
To file a workers' comp claim in California, first report your injury to your employer as soon as possible. Next, complete the necessary forms, including the DWC 1 form, and submit them to your employer. They will then provide you with the Dwc Ad Form 1013353sjdb to ensure your claim is processed correctly. For a smoother experience, consider using the uslegalforms platform for guidance and templates.
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