Utah Workers Compensation Questionnaire

State:
Multi-State
Control #:
US-Q1038
Format:
Word; 
Rich Text
Instant download

Description

This form addresses important matters that may effect the legal rights and obligations of the parties in a workers' compensation matter. This questionnaire enables those seeking legal help to effectively identify and prepare their issues and problems. Thorough advance preparation enhances the attorney’s case evaluation and can significantly reduce costs associated with case preparation.



This questionnaire may also be used by an attorney as an important information gathering and issue identification tool when forming an attorney-client relationship with a new client. This form helps ensure thorough case preparation and effective evaluation of a new client’s needs. It may be used by an attorney or new client to save on attorney fees related to initial interviews.


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How to fill out Workers Compensation Questionnaire?

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FAQ

Reporting the Injury: You must report your work-related injury or illness to your employer within 180 days (Approximately 6 months) or you may be entirely disqualified from receiving workers compensation benefits. As a practical matter, you really should report your injury as soon as possible.

When a worker is injured, each missed day of work represents lost wages. In workers' compensation insurance, indemnity benefits are paid to the employee to help them cover their loss of income. Payments are a portion of the worker's average weekly wage, and take into consideration the extent of the disability.

Compensation shall be 66-2/3% of the employee's average weekly wages at the time of the injury, but not more than a maximum of 66-2/3% of the state average weekly wage at the time of the injury and not less than a minimum of $45.00 per week plus $20.00* for a dependent spouse and $20.00 for each dependent child under ...

Workers' Compensation Coverage Verification (801) 530-6800. When clicking on the Workers' Compensation Coverage Verification link below, you will go to an external website maintained by the National Council on Compensation Insurance, Inc (NCCI).

The maximum duration for temporary total disability compensation is 312 weeks within a 12 year period of time from the date of injury. Permanent Partial Disability Compensation is paid if the injured employee's work injury or illness leaves them with a permanent impairment.

Utah's Basic Process to File a Workers' Compensation Claim Obtaining Medical Treatment & Reporting the Injury to the Employer. ... Reporting the Injury to the Insurance Carrier. ... Accepting or Denying the Workers' Comp Claim.

An impairment rating is used to calculate the amount of compensation an injured worker is entitled to. The impairment rating is the only variable in a simple calculation to determine the amount of compensation. The impairment rating is divided by 312 months, which is equivalent to six years.

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Utah Workers Compensation Questionnaire