Atacompfund.org
IA-1 WORKERS COMPENSATION – FIRST REPORT OF INJURY …
WebApplicable in Pennsylvania. Any person who knowingly and with intent to injure or defraud any insurer files a claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years or payment of a fine of up to $50,000. Applicable in Utah.
Actived: 9 days ago
EMPLOYER'S BASIC REPORT OF INJURY Michigan Department …
WebMichigan Department of Licensing and Regulatory Affairs Workers’ Compensation Agency PO Box 30016, Lansing, MI 48909. An employer shall report immediately to the agency on Form WC-100 all injuries, including diseases, which arise out of and in the course of the employment, or on which a claim is made and result in any of the following: (a
WORKERS COMPENSATION – FIRST REPORT OF INJURY OR …
WebEnter the name of the individual at the employer’s premises to be contacted for additional information. TYPE OF INJURY/ILLNESS: Briefly describe the nature of the injury or illness, (e.g. Lacerations to the forearm). PART OF BODY AFFECTED:99981231160000-0800. Indicate the part of body affected by the injury/illness, (e.g.
NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION …
WebIt must be filed even if the employer disputes the worker's claim of work-related injury or illness. WHERE TO FILE: Mail the original form to the New Mexico Workers' Compensation Administration (Attention: Statistics) at the address on t he front of this form. Copies must also be provided to the worker and the employer's workers' compensation
MPLOYER S REPORT OF EMPLOYEE S INJURY OR Emp. FEIN …
WebThis Form 19 is not your claim for workers’ compensation benefits. To make a claim, you must complete and sign the enclosed Form 18 and mail it to Claims Administration, N.C. Industrial Commission, 4335 Mail Service Center, Raleigh, NC 27699-4335 within two years of the date of your injury or last payment of medical compensation.
Candy Woodruff ATA Comp Fund
WebCandy joined the Fund as a member of our Risk Management team in January 2017 and in March 2024, was promoted to Senior Risk Manager. She is responsible for providing loss control & risk management services to our Fund Members in Central Alabama. Candy has over 35 years of experience in the trucking and safety professions through her roles as a
Abby Greer ATA Comp Fund
WebAbby joined our team in August 2016 as the Marketing & Media Specialist, and, in April 2024 was promoted to Marketing Manager. She is responsible for developing and executing strategic marketing campaigns for both programs, including internal and external communications. She is also a liaison for state trucking association partnerships
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