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WORKERS’ COMPENSATION PREVIEW Contents California Department of Human Resources


				
											        

    


    

		
			            

                

                    Sample Letter – 2 following issuance of initial invoice.
                    
Sample Letter – 2 following issuance of initial invoice.

                

            

		
			            

                

                    Example INJURED ON THE JOB?
                    
Example INJURED ON THE JOB?

                

            

		
			            

                

                    WHAT IS WORKERS’ COMPENSATION?  California’s  no-fault  workers’  compensation
                    
WHAT IS WORKERS’ COMPENSATION?  California’s  no-fault  workers’  compensation

                

            

		
			            

                

                    H T D
                    
H T D

                

            

		
			            

                

                    DISABILITY COMPENSATION AWARD UNDER 38 U.S.C. 1151 IMPORTANT INFORMATION
                    
DISABILITY COMPENSATION AWARD UNDER 38 U.S.C. 1151 IMPORTANT INFORMATION

                

            

		
			            

                

                    You may confirm insurance coverage at www.caworkcompcoverage.com.
                    
You may confirm insurance coverage at www.caworkcompcoverage.com.

                

            

		
			            

                

                    U.S. Department of Labor Notice of Employee's Injury or Death
                    
U.S. Department of Labor Notice of Employee's Injury or Death

                

            

		
			            

                

                    APPLICATION FOR EMPLOYMENT 20 North Main Street Brigham City, Utah 84302
                    
APPLICATION FOR EMPLOYMENT 20 North Main Street Brigham City, Utah 84302

                

            

		
			            

                

                    AGREEMENT BETWEEN EMPLOYER/EMPLOYEE CHOICE OF PHYSICIAN
                    
AGREEMENT BETWEEN EMPLOYER/EMPLOYEE CHOICE OF PHYSICIAN

                

            

			




    


    

        

            

                

                    
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