Untitled. Form mailed to OWCA when the first compensation payment is made and within 10 days of modification/suspension of such payment, a change to SEB, or the payment of a death benefit. 2025

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The document is a confidential Second Injury Fund Questionnaire designed to collect medical information from employees post-offer and pre-hire, in compliance with the Americans with Disabilities Act (ADA). It includes questions about past and current medical conditions, disabilities, and treatments, while ensuring that the information will be kept confidential and used for specific purposes related to employment and potential claims for reimbursement.

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