Fillable saif claim form

If you do not intend to file a workers compensation claim with SAIF Corporation do not sign the signature line. What if I have questions about my claim SAIF Corporation or your employer should be able to answer your questions. Notify SAIF Corporation within five days of knowledge of the claim. Even if the worker does not wish to file a claim maintain a copy of this form. 30. Toll-free phone Toll-free FAX CLAIM NO. SUBJECT DATE For SAIF Customer Use Area Dept. Shift CC 400 High St. SE Salem OR 97312 CLASS DEFAULT DATE 1. 922. 2689 503. 378. 3272 or Oregon Emergency Response 800. 452. 0311 on nights and weekends. 53. Date RESET PRINT A guide for workers recently hurt on the job The following information is provided by SAIF Corporation at...
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