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  • Workers Compensation Fund Of Utah Form 122

Get Workers Compensation Fund Of Utah Form 122

Print Form Reset Form (This Form Prints On Legal Paper) Form 122 WORKERS COMPENSATION FUND OF UTAH OSHA CASE/FILE # WORKERS COMPENSATION EMPLOYER S FIRST REPORT OF INJURY OR ILLNESS CONTAINS ALL ITEMS.

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Reporting a Work Injury or Illness It is important to ensure the report of an injury or illness is documented. If an injured employee fails to report an injury or illness within 180 days, they may be disqualified from receiving workers' compensation benefits.

When a worker is injured, each missed day of work represents lost wages. In workers' compensation insurance, indemnity benefits are paid to the employee to help them cover their loss of income. Payments are a portion of the worker's average weekly wage, and take into consideration the extent of the disability.

Compensation shall be 66-2/3% of the employee's average weekly wages at the time of the injury, but not more than a maximum of 66-2/3% of the state average weekly wage at the time of the injury and not less than a minimum of $45.00 per week plus $20.00* for a dependent spouse and $20.00 for each dependent child under ...

Compensation shall be 66-2/3% of the employee's average weekly wages at the time of the injury, but not more than a maximum of 66-2/3% of the state average weekly wage at the time of the injury and not less than a minimum of $45.00 per week plus $20.00* for a dependent spouse and $20.00 for each dependent child under ...

You can keep receiving temporary total disability until your physician believes that you have obtained maximum medical improvement (MMI), which means that your illness or injury is not expected to improve. The maximum availability of these benefits is 312 weeks.

First Report of Injury or Illness -- Forms 122C and 122E. Form 122C is used by the insurance carrier or self-insured employer to report an injury to the injured worker. Form 122E is used by the employer to report an injury to the injured worker and its insurance carrier or the Division, if uninsured.

For assistance, an injured worker, employer, medical provider or insurance carrier may contact the Industrial Accidents Division at (801) 530-6800 or toll free (in Utah) at (800) 530-5090.

To print and file a wage claim, you must complete UALD's Wage Claim Assignment Form. Return the completed form to UALD by hand delivering it to our office, mailing it to the address listed on the first page of the form, or fax the form to us at (801) 530-7609.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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