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

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

Document number F207-020-111
How to get this document
Keywords claim information, claims, espanol, industrial insurance, injuries, injury, self insurance, self insurer, self-insurance, self-insurer, spanish, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Alt Language(s) Español
Valid dates 08/2013
Contact information Claims for Job Injuries, Employer Services, Employer Services
Related information
Documents

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


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


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


Websites Insurance for Business, Self-Insured Employers

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