Get Form Ls 274

Filling out the Form Ls 274 accurately is essential for reporting open injury cases and ensuring compliance with regulations. This guide provides clear, step-by-step instructions to help you complete the form online with ease.

Follow the steps to fill out the Form Ls 274 online successfully.

1. Click ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering the insurance carrier or self-insured employer's name in the designated field.
3. Fill in the insurance carrier or self-insured employer's address, including number, street, city, state, and ZIP code.
4. Next, input the social security number of the claimant in the appropriate space.
5. In the following section, record the OWCP case name of the injured employee and their case number.
6. Indicate the act under which the injury falls and enter the date of injury in the specified format.
7. Describe the nature of the injury using approved abbreviations, such as Fx for fracture or spr for sprain.
8. Ensure that you detail the injury year, specifying from January 1 to December 31.
9. List the total amount of compensation paid to date, including both compensation and medical payments.
10. Provide an estimate of future compensation and medical payments in their respective sections.
11. Mark if the case is a fatal case or a third-party case as applicable.
12. Once all fields are completed, review your entries for accuracy and completeness before finalizing.
13. Save changes, download the completed form, print, or share it as necessary.

Complete your Form Ls 274 online today to ensure comprehensive reporting of injury cases.