Get Notice Of File Closing - Minnesota Department Of Labor And Industry

Filling out the Notice of File Closing form for the Minnesota Department of Labor and Industry is a crucial step in the workers' compensation process. This guide provides clear instructions to assist you in completing this form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the WID or social security number. This identification is essential for processing your claim. Ensure that you type this information correctly.
3. Next, fill in the date of injury in the specified MM/DD/YYYY format. This date is important for establishing the timeline of your claim.
4. Provide the name of the employee involved in the claim. This should be the individual whose injury is being addressed.
5. Enter the name of the employer associated with the claim. It is important to accurately reflect the business that employed the injured individual.
6. Input the insurer claim number. This number helps to reference the specific claim being filed.
7. The next section is to acknowledge that all payments and other activities related to the claim have been completed. This statement signifies your intent to close the file.
8. Enter the name of the claim representative responsible for managing this claim. Their information is crucial for any follow-up questions or verifications.
9. Fill in the date you are completing this form. This should also be in MM/DD/YYYY format.
10. Provide the complete address of the insurer, self-insurer, or TPA (Third Party Administrator). Include the city, state, and zip code.
11. Lastly, include a contact phone number, including the area code, where the representative can be reached for any inquiries.
12. Once all fields are completed, review the form for accuracy. You can then save your changes, download a copy, print it, or share it as needed.

Complete your Notice of File Closing online today for efficient processing.