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Get Notice Of Discontinuance Of Workers' Compensation Benefits Upon ...
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How to fill out the Notice of Discontinuance of Workers' Compensation Benefits online
Filling out the Notice of Discontinuance of Workers' Compensation Benefits can be a crucial step following the unfortunate event of an employee's passing. This guide aims to provide clear, step-by-step instructions to help users fill out the form accurately and efficiently online.
Follow the steps to complete the form smoothly.
- Click the ‘Get Form’ button to access the form and open it in your editing tool.
- Begin by entering the employee's full name in the spaces labeled 'Employee (last, first, mi)'. This ensures that the document accurately identifies the individual associated with the claim.
- Input the date of injury in the format MM/DD/YYYY, ensuring it reflects the correct date relevant to the worker's compensation case.
- Next, provide the employee's address, including city, state, and ZIP code, in the specified fields. This information is vital for official communication regarding the case.
- Enter the insurer claim number, which is essential for tracking the compensation benefits and any subsequent claims.
- Fill out the notification section by indicating the date of death of the employee. This establishes the reason for the discontinuance of benefits.
- Respond to the questions regarding the relationship of the employee’s death to the work-related injury by selecting 'Yes', 'No', or 'Unknown'. This section is critical for determining the next steps in the claims process.
- If the answer to the previous question is 'Yes', specify whether any ongoing compensation will be paid to heirs. Be sure to provide the duration if applicable.
- Review all the entered information for accuracy, ensuring that all fields are filled and properly reflect the facts surrounding the case.
- Once satisfied with the content, you can save the changes, download a copy for your records, print the form for submission, or share it as needed.
Take the necessary steps today to complete and submit your Notice of Discontinuance of Workers' Compensation Benefits online.
To make up for missed wages, an employee with a work-related injury or illness is eligible to receive up to two-thirds of their pre-injury average weekly earnings. Temporary total disability benefits begin after they can't work for more than three consecutive calendar days.
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