State Fund Employers Agreement To Accept Claim Assignment {BWC-1395} | Pdf Fpdf Doc Docx | Ohio

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State Fund Employers Agreement To Accept Claim Assignment {BWC-1395} | Pdf Fpdf Doc Docx | Ohio

Last updated: 1/30/2025

State Fund Employers Agreement To Accept Claim Assignment {BWC-1395}

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Description

BWC-1394 / C-262 - SELF-INSURED EMPLOYER’S CERTIFICATION OF ASSIGNMENT AFTER INITIAL ALLOWANCE. Complete this form in its entirety when you are accepting assignment of a claim that BWC or another party erroneously assigned to another self-insured employer. www.FormsWorkflow.com

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