Oklahoma Administrative Code
Title 302 - Group Self-Insurance Association Guaranty Fund Board
Chapter 10 - Procedures for Requesting Payment
Section 302:10-1-4 - Claim procedures
Universal Citation: OK Admin Code 302:10-1-4
Current through Vol. 42, No. 1, September 16, 2024
(a) The claim shall be in writing on a form provided by the Board for such purpose or in writing by the claimant and shall contain the following information:
(1) Name of claimant, Social Security number, if applicable, and address;
(2) Name of employer and group self-insurance association and claim number of Workers' Compensation claim;
(3) Nature of claim, whether temporary total disability, permanent partial disability, medical expenses, mileage or attorney fees;
(4) A statement of the amount of the claim;
(5) Copies of all pleadings filed in the Workers' Compensation claim; and
(6) Copies of all pleadings filed in District Court in an effort to execute on a judgment of the Workers' Compensation Court, if applicable.
(b) A claim in writing shall be filed with the Board within one year of notice that execution of a judgment by the District Court's order resulting from the certification of workers' compensation award is returned unsatisfied in whole or in part.
Added at 10 Ok Reg 3565, eff 7-12-93
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