Form 5020 Huntington Beach California 2025

Form 5020 Huntington Beach California: What You Should Know

Worker's compensation Claim Kit. Attachment 1 — Employer's Report Workers' compensation Claim Kit. Attachment 2 — Workers' Compensation Claim Form Housing Compensation Claim Kit. Attachment 3 — Claim Report Petition for Compensatory and/or Sufferance Benefits. Dated February 1, 2019, at 8:15 p.m. EST. Dated February 21, 2025 8-15-2019 DATE/TIME. Attachment 1 of 9. The claimant or employee or an authorized representative of the claimant has filed a claim against the United States for medical payments, disability compensation, special compensation (or other payments) from the United States, or loss of earnings under the Social Security Act or a federal law related to or affecting disability payments. The claim will be paid without interest in a person, firm or corporation authorized by law to receive claims from the United States; and the recipient has established a record of the payment and other facts that he has reliable information to support the payment. Attachment 2 of 9. The claimant or employee or an authorized representative of the claimant has filed a claim for pain and suffering under the Social Security Act or any federal law or federal regulation; a claim for pain and suffering under the Federal Fair Labor Standards Act, 29 U.S.C. 201 et seq. a claim for pain arising from service, whether performed by an employee or other party; a claim stemming from work on a ship, aircraft, rail vehicle, construction site, utility construction site, mining project, or construction equipment in interstate commerce; or a claim arising out of a natural disaster. The claimant has established a reliable claim history sufficient to determine the amount of pain and suffering due to the injuries. Attachment 3 of 9. The claimant's or employee's spouse has filed a claim as authorized by law. The claimant or employee has established a reliable history of the injury, work, or related event. Attachment 4 of 9. The claimant or employee is a federal or state prisoner. Attachment 5 of 9. The claim is from a party under the California Workers' Compensation Act. Attachment 6 of 9. The claim is from a party covered by an agreement of self-help. Attachment 7 of 9. The claim is from a party who is incarcerated for an offense, the punishment, or sentence of a court and has not had his or her judgment annulled. Attachment 8 of 9.

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