Get Affidavit Of Recovery

Filling out the Affidavit of Recovery is an important step in documenting an employee's return to work following a recovery from a work injury. This guide will provide you with clear and concise instructions to successfully complete this form online.

Follow the steps to complete your affidavit online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of injury in the designated field using the format MM/DD/YYYY.
3. Fill in the employee's social security number or workers' compensation ID number.
4. Provide the employee's claim number in the WCAIS claim number section.
5. Complete the employee's first name and last name fields.
6. Input the employee's address, including street, city/town, county, state, and ZIP code.
7. Enter the employee's date of birth in MM/DD/YYYY format.
8. Fill out the employer's information, including their first name, last name, address, county, state, ZIP code, and telephone number.
9. In the section certifying the employee's recovery, describe the work injury and confirm that the employee can resume their previous occupation without limitations.
10. Indicate the date of the physician's examination performed on the employee in the MM/DD/YYYY format.
11. The physician must attest to the accuracy of the affidavit and sign, including their first name, last name, and date.
12. Review the completed affidavit for accuracy and completeness.
13. Save changes, download, print, or share the form as needed.

Start filling out your Affidavit of Recovery online today.