Get Bdadj

Filling out the Bdadj form online may seem challenging, but this guide will assist you in every step of the process. By following these instructions, you can complete your claim for personal injury or on-the-job injury accurately and efficiently.

Follow the steps to complete your Bdadj form effectively.

1. Click the ‘Get Form’ button to obtain the Bdadj form and open it in your preferred document editor.
2. Begin by entering the claim number from your original claim. If this number is not included, the supplemental claim will be returned.
3. Provide the name of the State Agency you are filing your claim against, such as the Department of Transportation or Department of Education.
4. Input your personal information, including your name, address, telephone numbers, and email address. Ensure to include the last four digits of your Social Security Number or FEIN if you are filing for a business. If the injured party is a minor, fill in the name and age of the minor, along with the relationship of the person with whom the minor lives.
5. If you have an attorney, enter their information here. Note that correspondence will be directed to the attorney only if one is listed.
6. Indicate whether you are still employed by the employer listed on the original claim by checking ‘Yes’ or ‘No’. If you answered ‘No,’ enter the date your employment ended.
7. Enter the date when the original injury occurred.
8. List all medical expenses associated with this supplemental filing, including each healthcare provider, and the charges incurred. You may add extra sheets if necessary. Make sure to include evidence like itemized bills.
9. If you had medical insurance at the time of the injury, provide the names of the insurance companies and the amounts they paid directly to you for the claimed expenses.
10. If you are claiming medical disability, complete the necessary information regarding your disability status and provide evidence of maximum medical improvement.
11. Detail any lost wages and compensation for leave used due to the injury. List the total amount lost and verify your rate of pay.
12. Include any miscellaneous expenses related to the injury, such as damages to personal property or mileage. Indicate if any of the expenses are covered by insurance.
13. Calculate and enter the GRAND TOTAL amount you are claiming for all items described in the previous steps.
14. Sign the claim form in front of a Notary Public, print your name, and have the notary complete the necessary verification section.
15. Once you have filled out all sections and reviewed your claim for accuracy, save your changes, download, print, or share the form as needed.

Complete your Bdadj document online and ensure your claim is submitted correctly.