Get Wc-002a.doc

Filling out the WC-002a.doc, also known as the notice of payment or suspension of death benefits, can be a straightforward process when approached step-by-step. This guide will assist you in filling out the form accurately and submitting it online.

Follow the steps to complete the WC-002a.doc effectively.

1. Click ‘Get Form’ button to access the WC-002a.doc and open it in the editing interface.
2. Begin filling out section A, which includes providing identifying information. Here, you should enter the board claim number, the employee's last name, first name, middle initial, and social security number.
3. Continue with the date of injury field, then complete the claimant or guardian's information by entering their name, address, city, state, and zip code.
4. Next, proceed to the insurer or self-insurer section. Fill in the name and contact details of the insurer or self-insurer, including the phone number and file number.
5. In the employer section, provide the employer's name, address, and phone number, ensuring that all details are accurate.
6. Complete the claims office section by entering the corresponding details of the claims office, including address and contact information.
7. Move on to section B, where you will specify the death benefits. Fill in the payment rate based on the average weekly wage, the amount of penalty if applicable, and the date of the first check.
8. For the benefits suspension details, provide the date benefits will be suspended, the suspended amount, and the date of death, along with the reason for suspension.
9. In section C, total dependents, list their names, addresses, phone numbers, birthdates, and relationships to the deceased individual. Use additional sheets if necessary.
10. If applicable, complete section D for partial dependents by providing their detailed information.
11. Check the box for no dependents if there are none, including the necessary details if required.
12. Finalize the form by typing or printing your name, adding your signature, email, date, and phone number.
13. Finally, ensure all fields are filled correctly before saving changes, downloading, printing, or sharing the completed form per your needs.

Complete the WC-002a.doc online today to ensure timely processing of benefits.