Db 820 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the WCB Plan # and Employer FEIN at the top of the form. This information is crucial for identifying your insurance coverage.
3. In the section labeled 'Name of Employer', input the full name of your organization, followed by the 'Name of Carrier' which refers to your insurance provider.
4. Next, fill out the 'CLASS OR CLASSES OF EMPLOYEES' field, specifying which employee categories are covered under this plan.
5. For each class, provide details on 'BENEFIT AMOUNT MAXIMUM OR RATE', 'DURATION (Weeks)', 'WAITING PERIOD (Days)', and 'ELIGIBILITY REQUIREMENT'. Ensure that these figures comply with Article 9 of the Workers' Compensation Law.
6. If necessary, attach additional sheets for any other benefits or restrictions that differ from those specified in the law.
7. Finally, review all entries for accuracy before saving or submitting your completed form through our platform.

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