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Get AL WCC10 Assessment Form Instructions

WCC10 Alabama Assessment Form Instructions Reporting period January 1 December 31 Mailed 1st week of January Due March 1st Annually A PENALTY OF 25. 00 A DAY WILL BE ASSESSED FOR FORMS RECEIVED AFTER MARCH 1ST Total Compensation All payments paid to claimant to include TTD TPD PPD and PTD. Total Medical All payments made to medical providers to include Hospitals Doctors Chiropractors Home Health Mileage Future Medical payments etc* Administrative Expenses Legal Expenses Utilization Review Case Management Fees paid for post-accident drug testing Investigation etc* Plaintiff Attorney fees Depositions Subpoenas Court Cost etc* Court Settlements Court Ordered Settlements or Lump Sum Settlements. These settlements may be included in the compensation and/or medical If so do not list the settlements again* If you do not have Microsoft Word or HAVE difficulties downloading the form* Please email Mary JoRGENSON at Assessments labor. 00 A DAY WILL BE ASSESSED FOR FORMS RECEIVED AFTER MARCH 1ST Total Compensation All payments paid to claimant to include TTD TPD PPD and PTD. Total Medical All payments made to medical providers to include Hospitals Doctors Chiropractors Home Health Mileage Future Medical payments etc* Administrative Expenses Legal Expenses Utilization Review Case Management Fees paid for post-accident drug testing Investigation etc* Plaintiff Attorney fees Depositions Subpoenas Court Cost etc* Court Settlements Court Ordered Settlements or Lump Sum Settlements. Total Medical All payments made to medical providers to include Hospitals Doctors Chiropractors Home Health Mileage Future Medical payments etc* Administrative Expenses Legal Expenses Utilization Review Case Management Fees paid for post-accident drug testing Investigation etc* Plaintiff Attorney fees Depositions Subpoenas Court Cost etc* Court Settlements Court Ordered Settlements or Lump Sum Settlements. These settlements may be included in the compensation and/or medical If so do not list the settlements again* If you do not have Microsoft Word or HAVE difficulties downloading the form* Please email Mary JoRGENSON at Assessments labor. 00 A DAY WILL BE ASSESSED FOR FORMS RECEIVED AFTER MARCH 1ST Total Compensation All payments paid to claimant to include TTD TPD PPD and PTD. Total Medical All payments made to medical providers to include Hospitals Doctors Chiropractors Home Health Mileage Future Medical payments etc* Administrative Expenses Legal Expenses Utilization Review Case Management Fees paid for post-accident drug testing Investigation etc* Plaintiff Attorney fees Depositions Subpoenas Court Cost etc* Court Settlements Court Ordered Settlements or Lump Sum Settlements. These settlements may be included in the compensation and/or medical If so do not list the settlements again* If you do not have Microsoft Word or HAVE difficulties downloading the form* Please email Mary JoRGENSON at Assessments labor. .

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