Work Injury Supplemental Benefit Fund Barred Claim
Document Number: WKC-16804-E
Description: This form is to be completed by an employee or their attorney for initiating barred claims against the Work Injury Supplemental Fund.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). If you do not have Microsoft Word we have also provided a pdf file for you to print and complete by hand.
Content Contact: Kathy Froehlich
WKC-16804-E (Electronic Version - Word/66 KB)
WKC-16804 (Print Version - pdf/19 KB)
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