(3) Filing a claim does not request a hearing nor is the representative required to file a employer’s Form 51 or 53. C. A letter filed with the Commission also files a claim. The letter should include the information listed in items (1) through (13) below: (1) name if different); Claimant’s (and worker’s name, (2) address address, if different); Claimant’s (and worker’s (3) home and work telephone numbers home and work telephone Claimant’s (and worker’s numbers, if different); (4) social security social security number, if different); Claimant’s number (and worker’s (5) name; Employer’s (6) address; Employer’s (7) telephone number; Employer’s (8) insurance carrier, if known; Employer’s (9) Date of injury; (10) The county in which the injury occurred; (11) Type of injury (to which area of body); (12) Description of the accident; (13) The WCC file number or Coverage Coding Form must be included. D. Failure to include any of the information above does not bar the claim if the information necessary to an issue in the claim is given to the Commission upon request. E. The Commission will notify the representative a claim has been filed. The employer’s employer’s representative shall immediately contact the claimant. 67207. Requesting a Hearing, Claimant. A. To request a hearing, file a Form 15, Form 50, or Form 52 with the Judicial Commission’s Department as provided below: (1) Mark the box at the signature line on the Form 50 or Form 52 which states, am requesting a “I or sign and date under Section III of the Form to Injured Worker or Legal hearing,” 15 “Notice Representative When Temporary Compensation Has Been Stopped.” (2) Address and deliver the form to the Judicial Department.
(3) Filing a claim does not request a hearing nor is the employer’s representative required to file a Form 51 or 53. C. A letter filed with the Commission also files a claim. The letter should include the information listed in items (1) through (13) below: (1) Claimant’s name (and worker’s name, if different); (2) Claimant’s address (and worker’s address, if different); (3) Claimant’s home and work telephone numbers (and worker’s home and work telephone numbers, if different); (4) Claimant’s social security number (and worker’s social security number, if different); (5) Employer’s name; (6) Employer’s address; (7) Employer’s telephone number; (8) Employer’s insurance carrier, if known; (9) Date of injury; (10) The county in which the injury occurred; (11) Type of injury (to which area of body); (12) Description of the accident; (13) The WCC file number or Coverage Coding Form must be included. D. Failure to include any of the information above does not bar the claim if the information necessary to an issue in the claim is given to the Commission upon request. E. The Commission will notify the employer’s representative a claim has been filed. The employer’s representative shall immediately contact the claimant. 67207. Requesting a Hearing, Claimant. A. To request a hearing, file a Form 15, Form 50, or Form 52 with the Commission’s Judicial Department as provided below: (1) Mark the box at the signature line on the Form 50 or Form 52 which states, “I am requesting a hearing,” or sign and date under Section III of the Form 15 “Notice to Injured Worker or Legal Representative When Temporary Compensation Has Been Stopped.” (2) Address and deliver the form to the Judicial Department.
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