Get Application To Reinstate Payment

Filling out the application to reinstate payment of disability compensation can be straightforward with the right guidance. This guide will provide you with clear steps to accurately complete the form online, ensuring that you include all necessary information.

Follow the steps to effectively complete the application

1. Click ‘Get Form’ button to obtain the application and open it in your preferred editing platform.
2. Begin by entering your personal details. This includes your name, address, and contact information, ensuring all fields are accurately filled.
3. Input your date of injury and describe the nature and extent of your injury or occupational disease in the designated section.
4. Indicate whether your claim has been accepted by the Industrial Commission. If applicable, select the relevant form from the options provided.
5. Specify the number of weeks compensation you have already received, with the corresponding dates clearly noted.
6. State the date from which you are seeking compensation, along with your reason for reinstatement. Make sure to attach any necessary supporting documentation.
7. Provide a telephone number where you can be reached for any informal hearing that may be scheduled.
8. After completing Section A, ensure to send a copy of the application and supporting documents to the employer or carrier.
9. Finally, review all the information provided for accuracy and clarity. Save your changes, then download, print, or share the completed form as needed.

Complete your documents online with confidence and ensure timely submission.