Claim Maintenance - Claim

Has an Accident Insurance Treatment Certificate been issued?

Select "Yes" or No". Selecting "Yes" activates the fields below - enter the details of the insurance certificate.

Did you have to stop working due to the accident?

Select "Yes" or No". Selecting "Yes" activates the fields below - enter the date and time that the employee stopped working.

Are you claiming for salary or wages lost as a result of this work-related personal injury?

Select "Yes" or No". Selecting "Yes" activates the table below - complete the table, covering the employee's work history for the last 12 months, who they worked for and how long.