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Get Teamcare Claim Form 2 HW8AB 2019-2024

Imated date for your return to work is required. 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 TeamCare-STD-Claim-Form-2-Continued-Report-of-Disability.doc 20161212 (20190514) HW8AB.

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