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Form MN AR04 Annual Claim for Reimbursement From the Second Injury Fund - Minnesota
What Is Form MN AR04?
This is a legal form that was released by the Minnesota Department of Labor and Industry - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the MN AR04 Annual Claim for Reimbursement?
A: The MN AR04 Annual Claim for Reimbursement is a form used in Minnesota to request reimbursement from the Second Injury Fund.
Q: Who can file the MN AR04 Annual Claim for Reimbursement?
A: Employers, insurers, and self-insured entities can file the MN AR04 Annual Claim for Reimbursement.
Q: What is the Second Injury Fund?
A: The Second Injury Fund is a fund in Minnesota that provides compensation to injured workers with pre-existing disabilities who suffer additional work-related injuries.
Q: What expenses can be reimbursed through the MN AR04 Annual Claim?
A: Medical expenses, wage loss benefits, and rehabilitation costs related to the second injury can be reimbursed through the MN AR04 Annual Claim.
Q: What other documents are required to file the MN AR04 Annual Claim for Reimbursement?
A: Additional documents such as medical reports, wage statements, and rehabilitation plans may be required to support the claim.
Form Details:
- Released on September 1, 2015;
- The latest edition provided by the Minnesota Department of Labor and Industry;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form MN AR04 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Labor and Industry.
Download Form MN AR04 Annual Claim for Reimbursement From the Second Injury Fund - Minnesota
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