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How to use or fill out Injured Worker Information with our platform
- Click ‘Get Form’ to open the Injured Worker Information document in the editor.
- Begin by entering the Claim Number at the top of the form. This is essential for tracking your appeal.
- Fill in the Employer Information section, including the employer's name, address, city, state, zip code, telephone, and fax number.
- Next, provide your information as the Injured Worker. Include your name and contact details in the designated fields.
- In the Injured Worker’s Representative Information section, if applicable, enter your representative's details including their Rep ID#, name, telephone, and fax.
- Complete the Reason for Appeal section by clearly stating your reasons. If you intend to file new evidence not available at the last hearing, check 'Yes' or 'No'.
- Finally, review all entered information for accuracy before signing and submitting your appeal notice.
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