Get Workers Compensation Fund Of Utah Form 122

Navigating the workers compensation process can be challenging, but filling out the WORKERS COMPENSATION FUND OF UTAH Form 122 online can simplify the task. This guide provides a step-by-step approach to ensure you accurately complete the form while understanding each component.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the general information section. This includes entering the employer's name, address, and contact details, as well as the claims administrator's information. Ensure that you provide accurate details to prevent any processing delays.
3. Next, provide the employee's personal information. Fill in their full name, date of birth, social security number, and marital status. It is important to ensure this data is correct to avoid issues with the claim.
4. Document the details of the injury or illness. Include the date of injury, occupation, type of injury, and the sequence of events leading to the injury. This section is crucial for proper assessment of the claim.
5. Complete the section regarding medical treatment and ensure you include the details of the health care provider. This includes the name and address of the physician who treated the employee.
6. Fill out the witness information if applicable, along with any safety measures or equipment that were in place during the incident.
7. Lastly, review all entered information for accuracy. Once you are satisfied with the details, you can save changes, download, print, or share the form as necessary.

Ensure your workers compensation claims are completed accurately by following these steps online.