Get Co-operation And Mitigation In Recoveryworkers ...

This guide provides comprehensive instructions on how to fill out the Co-operation And Mitigation In Recovery Workers form online. It is designed to assist all users, regardless of their legal experience, in completing the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred digital editing tool.
2. Enter the date of injury or illness in the designated field. Make sure this date corresponds with the information previously reported.
3. Input the WCB case number and the claim administrator’s case number, ensuring these identifiers match the relevant documents.
4. Provide the employee's information including last name, first name, mailing address, city, state, zip code, daytime phone number, country, email address, social security number, gender, and date of birth.
5. Fill in the employer's information, which comprises the employer name, mailing address, city, state, phone number, country, and zip code.
6. Select the type of Tax ID provided by the employer — either Federal Tax ID or SSN/EIN.
7. Complete the insurer's information, including insurer name, ID number, mailing address, city, state, country, zip code, and phone number.
8. Record the date of the first full day the employee was lost from work and the date the employee first returned to work.
9. Detail any loss of time resulting from the injury, including start date, return to work date, and reason for the absence.
10. Indicate if there was an increase or decrease in hours worked or wages paid as a result of the injury. If yes, fill in the employment status, effective date, hours per day, days per week, and earnings.
11. Lastly, ensure all prepared by information (last name, first name, employer name, official title, phone number, email address, and date of the report) is complete.
12. After filling out the form, save changes, download, print, or share the document as required.

Take the first step in managing your documents by completing the Co-operation And Mitigation In Recovery Workers form online.