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Get Teamcare Claim Form 2 HW8AB 2016

D. If left blank or stated as unknown, automatic payments will be affected. Employer’s Statement  Employer’s Statement is only required if you have returned to work. Please call 800-TEAMCARE if you return to work prior to the date given by your doctor. g\g\f\f\STD\STD Claim Form 2 – Continued Report of Disability.doc – 20160418 HW8AB .

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