PDF
Word
DOL Form 22 Agreement for Permanent Partial or Permanent Total Disability Compensation - Vermont
What Is DOL Form 22?
This is a legal form that was released by the Vermont Department of Labor - a government authority operating within Vermont. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DOL Form 22?
A: DOL Form 22 is an Agreement for Permanent Partial or Permanent Total Disability Compensation in Vermont.
Q: What is the purpose of DOL Form 22?
A: The purpose of DOL Form 22 is to document an agreement between an injured worker and an employer regarding permanent disability compensation.
Q: Who needs to use DOL Form 22?
A: DOL Form 22 should be used by an injured worker and their employer in Vermont when they reach an agreement on permanent disability compensation.
Q: What is permanent partial disability?
A: Permanent partial disability refers to a permanent impairment or injury that affects a worker's ability to perform certain tasks or activities, but does not completely prevent them from working.
Q: What is permanent total disability?
A: Permanent total disability refers to a permanent impairment or injury that completely prevents a worker from engaging in any gainful employment.
Q: What information is required on DOL Form 22?
A: DOL Form 22 requires information such as the injured worker's name, employer's name, disability rating, and the details of the agreed-upon compensation.
Q: How should DOL Form 22 be submitted?
A: DOL Form 22 should be completed and signed by both the injured worker and employer before being submitted to the Vermont Department of Labor for approval.
Q: What happens after submitting DOL Form 22?
A: After submitting DOL Form 22, the Vermont Department of Labor will review the agreement and determine if the compensation is fair and appropriate.
Q: Can the agreement on DOL Form 22 be modified?
A: Yes, if there are changes in the injured worker's condition or circumstances, the agreement on DOL Form 22 can be modified with the approval of the Vermont Department of Labor.
Form Details:
- Released on June 1, 2010;
- The latest edition provided by the Vermont 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 DOL Form 22 by clicking the link below or browse more documents and templates provided by the Vermont Department of Labor.
