Self-Insured Employers' Medical Only Claim Closure Order and Notice - Cambodian

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Title Self-Insured Employers' Medical Only Claim Closure Order and Notice - Cambodian (A fillable form - 148 KB PDF)
Description Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid.
Detail
Form number F207-020-666
Availability
Online only. See document above to download.
Keywords claim information, claims, industrial insurance, injuries, injury, self insurance, self insurer, self-insurance, self-insurer, time-loss, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Languages Cambodian , English
Valid dates All dates valid
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Self-Insurance
Related information
Documents Self-Insured Employers' Time Loss Claim Closure Order and Notice
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL
Web pages Self-Insured Employers
Insurance for Business

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