Form 13 WCA Employer's Supplemental Report of Injury - New Hampshire

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.

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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.

Download Form 13 WCA Employer's Supplemental Report of Injury - New Hampshire

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  • Form 13 WCA Employers Supplemental Report of Injury - New Hampshire, Page 1
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