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WC7789r Notice and Instructions to Employers and Hanover  Form

WC7789r Notice and Instructions to Employers and Hanover Form

Use a WC7789r Notice And Instructions To Employers And Hanover template to make your document workflow more streamlined.

Injured employee or the employee s dependents as provided in the Act. Signature of Employer 440 Lincoln St. Worcester MA 01653 Insurer Name and Address Mediation is available to help resolve certain workers compensation disputes. For information call the Counselor Division at 405-522-5308 or InState Toll Free 855-291-3612. Date of Expiration of Insurance Policy Not applicable to employers authorized to self-insure. Employee s Responsibilities In Case of Work Related Injury If accidentally...
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