Employees Objection To Wage Transcript {DWC-31} | Pdf Fpdf Doc Docx | Rhode Island

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Employees Objection To Wage Transcript {DWC-31} | Pdf Fpdf Doc Docx | Rhode Island

Employees Objection To Wage Transcript {DWC-31}

This is a Rhode Island form that can be used for Claim within Workers Comp, Department Of Labor And Training.

Alternate TextLast updated: 11/30/2016

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State of Rhode Island EMPLOYEE'S OBJECTION TO WAGE TRANSCRIPT Department of Labor and Training, Division of Workers' Compensation PLEASE CHECK IF CORRECTION OF PRIOR REPORT DWC No. Insurer File No. PO Box 20190, Cranston, RI 02920-0942 Phone (401) 462-8100 TDD (401) 462-8006 1. EMPLOYEE INFORMATION: SSN Name Address City, State, Zip Phone 2. CLAIM INFORMATION: Employer Insurance Co. Claim Administrator Injury date Incapacity date The employee objects to the discontinuance or reduction of workers' compensation benefits pursuant to RIGL Section 28-35-47 and requests a review by the Workers' Compensation Court, pursuant to RIGL Section 28-35-51. Employee: Date: DWC-31 (01/03) For instructions visit our web site: www.dlt.ri.gov/wc American LegalNet, Inc. www.FormsWorkFlow.com

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