KELLY, LLC, - iic idaho 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the claimant's name and details in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Proceed to fill out the employer's information, including J. H. KELLY, LLC, and any relevant identifiers associated with the case.
4. In the issues section, clearly indicate whether you are claiming temporary total disability (TTD) benefits or permanent partial disability (PPD) benefits. Use checkboxes or text fields as provided.
5. Attach any necessary documentation or evidence that supports your claims. This may include medical records or previous correspondence related to your case.
6. Review all entered information for completeness and accuracy before submitting the form through our platform.

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