Self-Insured Employers' Time Loss Claim Closure Order and Notice

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Title Self-Insured Employers' Time Loss Claim Closure Order and Notice
Description

Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid.

Document number F207-070-000
How to get this document
Alt Language(s) Español
Valid dates 08/2013
Contact information Claims for Job Injuries, Employer Services, Employer Services
Related information
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Self-Insured Employers' Medical Only Claim Closure Order and Notice


Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL


Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL


Websites Insurance for Business, Self-Insured Employers

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