Notice of Closure Worksheet - Injury Prior to January 1, 2005 - Oregon-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the insurer's name, address, and phone number at the top of the form. This information is crucial for proper communication regarding your claim.
3. Fill in the WCD file number and the worker’s legal name along with their date of birth. Ensure accuracy as this information links directly to your claim.
4. Select the type of notice from the provided options. Each option corresponds to different circumstances surrounding your injury, so choose carefully based on your situation.
5. Complete sections detailing prior awards of permanent partial disability (PPD) and any other claims. Be thorough in documenting dates and values associated with these claims.
6. In Section 4, check applicable impairment factors and enter body parts involved. This section is vital for calculating disability accurately.
7. Finally, review all entries for completeness and accuracy before saving or submitting your form through our platform.

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