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Get MetLife GRPACCIDENTCLM1 2013-2024

Njury, attach a copy of the first report of injury filed with your employer. Date of accident (Month/Day/Year) Location of the accident - City State Describe how the accident happened (Include additional information on a separate sheet of paper if needed.) Was the patient the driver in a motor vehicle accident? £ Yes (Attach the police report.) £ No Was the patient involved in any other type of accident that required a police report? £ Yes (Attach the police report.) £ No Was the patient.

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