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Click ‘Get Form’ to open the rebuttal application 2011 form in the editor.
Begin by entering the WCB Case Number(s) and Carrier Case Number(s) at the top of the form. This information is crucial for identifying your case.
Fill in the Date of Injury, Carrier's Name, and Claimant's Name along with their respective addresses. Ensure accuracy as this information is vital for processing your rebuttal.
In Section 1, indicate on whose behalf you are making the rebuttal by selecting either Claimant, Employer/Carrier, or Special Funds.
Choose the type of application you are responding to in Section 2. Options include Uninsured Employers' Fund or Mandatory/Discretionary Full Board Review.
Complete any additional fields regarding findings of fact or conclusions of law as necessary, ensuring all relevant details are included.
Finally, sign and date the document in the certification section to validate your submission before sending it through your preferred method.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (57 Votes)
2018	4.3 Satisfied (109 Votes)
2011	4.4 Satisfied (532 Votes)

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