Get Department Of Labor Objection To Discontinuance Form

The Department of Labor Objection To Discontinuance Form is a critical document for individuals disputing a decision regarding their workers' compensation benefits. This guide offers step-by-step instructions to help you complete this form accurately and effectively when filing online.

Follow the steps to complete your objection form online

1. Press the ‘Get Form’ button to access the Department of Labor Objection To Discontinuance Form. This action will open the form in your selected online editor or viewing platform.
2. Begin filling out the form by providing the date(s) of your claimed injury in the MM/DD/YYYY format. It is essential to be accurate with this information, as it relates to your workers' compensation case.
3. Complete the section regarding the employer and insurer information. Include the name of the employer and the insurer as they are officially recognized in your case documentation.
4. Identify the basis for your objection to discontinuance by indicating whether your objection responds to an administrative decision or a notice. Fill in the name of the judge or the relevant information regarding the discontinuance notice as applicable.
5. Specify the additional benefits you are claiming. This may include Temporary Total, Temporary Partial, or Permanent Total disability benefits, along with the relevant dates for each claim.
6. Indicate any required trial data if you are requesting a pretrial or trial, including the estimated hours needed to present evidence and whether any interpreter or reasonable accommodation is required.
7. Review the entire form for completeness and accuracy. After confirming all required fields are filled out properly, ensure that you sign the form, as well as having your attorney sign it if applicable.
8. Finally, save your changes. You may download a copy of the completed form, print it for your records, or share it as required. Make sure to serve a copy to the employer and insurer by the specified method.

Complete your Department of Labor Objection To Discontinuance Form online to ensure your workers' compensation rights are represented.