Statement Of Compensation Paid {WCB-11} | Pdf Fpdf Docx | Maine

 Maine   Workers Compensation 
Statement Of Compensation Paid {WCB-11} | Pdf Fpdf Docx | Maine

Last updated: 3/22/2024

Statement Of Compensation Paid {WCB-11}

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Description

WCB-11 - STATEMENT OF COMPENSATION PAID. This form is used by the Maine Workers' Compensation Board to report compensation paid to employees for work-related injuries or illnesses. The form includes sections for information such as the employee's name, social security number, address, date of injury, specific injury or illness, employer and insurer details, reason for the report (interim or final), and a summary of payments made, including medical treatment, death benefits, weekly compensation, legal expenses, permanent impairment, employment rehabilitation, interest, and lump sum settlements. www.FormsWorkflow.com

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