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Form 13 WCA Employer's Supplemental Report of Injury - New Hampshire
What Is Form 13 WCA?
This is a legal form that was released by the New Hampshire Department of Labor - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 13 WCA?
A: Form 13 WCA is the Employer's Supplemental Report of Injury specific to the state of New Hampshire.
Q: Who needs to fill out Form 13 WCA?
A: Employers in New Hampshire need to fill out Form 13 WCA when reporting work-related injuries.
Q: What information is required on Form 13 WCA?
A: Form 13 WCA requires information such as the employee's personal details, details of the injury, medical treatment received, and the date of reporting.
Q: When should Form 13 WCA be submitted?
A: Form 13 WCA should be submitted within 10 days of the employer's knowledge of the injury, or within 30 days if there is a reasonable justification for the delay.
Q: What happens after submitting Form 13 WCA?
A: After submitting Form 13 WCA, the employer's insurance carrier will review the information and make a determination on the claim.
Form Details:
- Released on March 1, 2014;
- The latest edition provided by the New Hampshire Department of Labor;
- 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 13 WCA by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Labor.
