DATE:

September 24, 2008

TO:

All Insurance Companies, Self-Insured Employers, Group Funds

FROM:

Jack Nolish, Director

RE:

Claims Forms

We are continuing to receive a number of claims forms that we are unable to read (either the original and/or our microfilmed copy) because, among other things, they are handwritten, reduced in size, or printed in very light ink or with too small of a font size.

Therefore, effective October 1, 2008, all WC-100, WC-106, WC-107, WC-110, and WC-701 forms submitted to the Workers' Compensation Agency must be typed (in 10 point font or greater).   The forms also should not be reduced from their original size.  Any handwritten or otherwise illegible claims forms we receive after that date will be returned.

In addition, please make sure that the employee's entire 9-digit Social Security number is present on all forms.  Our agency is permitted to require this number under the Social Security Number Privacy Act because the use of this information began before March 1, 2005, the effective date of the Act, and the use is ongoing and continuous as part of our ordinary course of business.  Any forms which do not contain the entire 9-digit number will be returned.

Your adherence to these policies is greatly appreciated.