Claim form for workers compensation 2025

1. Click ‘Get Form’ to open the claim form for workers compensation in the editor.
2. Begin by filling out the CLIENT INFORMATION section. Enter your name, address, phone numbers, and email. Ensure that your Social Security Number and date of birth are accurate.
3. Proceed to the EMPLOYMENT/INSURANCE/UNION MEMBERSHIP section. Provide details about your primary employer, including their address and your wage. If applicable, include information about any secondary employment.
4. In the INJURY section, specify the date of injury and describe how and where it occurred. Be thorough in detailing body parts injured.
5. Complete the PRIOR CLAIMS section if you have previous workers' compensation claims. Include dates and amounts awarded.
6. Fill out the DEADLINES TO CALENDAR section carefully to track important dates related to your claim.
7. Finally, review all sections for accuracy before saving or submitting your completed form through our platform.

Start using our platform today to simplify your workers' compensation claim process!