Form 5020 for Wyoming 2025

Form 5020 for Wyoming: What You Should Know

Denver, CO 80202  or DEPARTMENT OF WORKSTATION SERVICES. Department of Public Safety 1401 E. Santa Fe Drive, Suite 300 Denver, CO 80219  or ELIMINATE AFFECTIONS FORM If the injured worker has any disabilities, the employer or employer's agent needs to complete and sign this form. Filing and Paying The filing of a Form 20 will create two documents. One will be our report of injury. (See Form20) and the other report will be an Affidavit: Clerical Office Occupation Classification (Workers' Compensation only). Either form may be filed at anytime. If Form 20 is filed in accordance with our regulations, a report of injury will be filed with the clerk of the county court with the employee's name, his occupation and his employer's name. If the injuries are not reported in accordance with WPA regulations, a report of injury will be filed with the clerk of the county court with the name of the employee, his occupation and his employer's name. Any adverse actions in either form will be reported to the State Comptroller for payment to the injured employee's insurance. Payment of WPA Liability Any compensation claimed must be paid by the State Comptroller. For more information as to how to file a claim please contact the State Comptroller's Offices in Denver and El Paso at or. Note: If the injured worker is an employee of the county, and his employer files and pays workers' compensation or an employee's check is deposited into a state or federal workers' compensation fund, the employees medical benefits should be paid out by the appropriate agency. Pension Contributions For Those Disabled Under Wyoming Statutory Laws If your wages are paid in a form which can be credited to a Workers' Compensation fund and/or which may be deducted from your paycheck (such as a Workers' Comp trust), then you should include with your WPA Form 20 a contribution for the workers' compensation fund. To do so, complete a Part 3 of Form 40. When signing this Form, you should put the worker's name, employer's name, occupation, and date of injury. You'll be asked for the employer's Social Security number and your address.

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