AL WC Form 18 2012-2026 free printable template

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WC Form 18 Revised 10/12 EMPLOYER S APPLICATION FOR SELF INSURANCE Submit one completed copy CONFIDENTIAL To the DEPARTMENT OF LABOR The undersigned an employer subject to the provisions of the Alabama Workers Compensation law as last amended hereby applies for the privilege of self-insuring the payment of compensation provided in that law and submits the following facts under oath to the Department of Labor to enable it to determine if sufficient financial ability exists to render certain...

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How to fill out AL WC Form 18

01

Begin by obtaining a copy of the AL WC Form 18 from the Alabama Workers' Compensation website or your employer.

02

Fill in your personal information, including your name, address, and contact details, at the top of the form.

03

Provide the date of the accident or injury in the designated section.

04

Describe the nature of the injury and how it occurred clearly and concisely.

05

Include details about your employer, such as their name and address.

06

If applicable, list any witnesses or individuals who can provide additional information about the incident.

07

Sign and date the form to certify that the information provided is true and accurate.

08

Submit the completed form to your employer or the relevant workers' compensation authority as instructed.

Who needs AL WC Form 18?

01

Employees who have been injured at work and are seeking to file a claim for workers' compensation benefits need AL WC Form 18.

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What is AL WC Form 18?

AL WC Form 18 is a form used in Alabama for reporting workers' compensation claims related to work-related injuries or illnesses.

Who is required to file AL WC Form 18?

Employers in Alabama are required to file AL WC Form 18 when an employee has sustained a work-related injury or illness that necessitates a claim for workers' compensation benefits.

How to fill out AL WC Form 18?

To fill out AL WC Form 18, provide accurate information about the injured employee, the nature of the injury or illness, details of the incident, and any medical treatment received. Ensure all sections are completed as required.

What is the purpose of AL WC Form 18?

The purpose of AL WC Form 18 is to formally document a workers' compensation claim and provide necessary information for the processing of the claim by the relevant authorities.

What information must be reported on AL WC Form 18?

AL WC Form 18 must report the employee’s personal information, details of the injury or illness, date and time of the incident, the nature of work performed at the time, any witnesses, and medical treatment received.

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