Claim Maintenance - Supporting

Has the employee previously suffered from any similar injury or disease?

Select "Yes" or No". Selecting "Yes" activates the table below - complete the table, covering the date and details of the injury incurred, and who the employee was working for at the time.

Does the employee have any other employment?

Select "Yes" or No". Selecting "Yes" activates the fields below - specify that name, address and phone numbers of the other employer(s).

Do the employee have any personal health related insurance?

Select "Yes" or No". Selecting "Yes" activates the field below - specify the name and branch of the insurance provider.