ND WSI SFN 2828 2007-2025 free printable template
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1600 EAST CENTURY AVENUE, SUITE 1 PO BOX 5585 BISMARCK ND 58506-5585 Telephone 1-800-777-5033 Toll Free Fax 1-888-786-8695 TTY (hearing impaired) 1-800-366-6888 Fraud and Safety Hotline 1-800-243-3331
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How to fill out nd injury form
How to fill out ND WSI SFN 2828
01
Obtain the ND WSI SFN 2828 form from the North Dakota Workforce Safety & Insurance website or a local office.
02
Start by filling out your personal information in the designated fields, including your name, address, and contact details.
03
Provide your Social Security Number (SSN) in the relevant section.
04
Indicate your date of birth and any other required identifying information.
05
Specify the type of claim you are filing in the appropriate box.
06
Describe the details of your injury or illness thoroughly, including the date it occurred and the circumstances surrounding it.
07
If applicable, provide information about medical treatment received and any healthcare providers involved.
08
Sign and date the form at the bottom to certify that the information provided is accurate to the best of your knowledge.
09
Review the entire form for completeness before submission, ensuring all required sections are filled out.
10
Submit the completed form to the ND Workforce Safety & Insurance office via mail or electronically as directed.
Who needs ND WSI SFN 2828?
01
Individuals who have sustained a work-related injury or illness and are seeking workers' compensation benefits in North Dakota.
02
Employers may also need to be familiar with the form to assist their employees in the filing process.
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People Also Ask about wsi report injury
Which states are monopolistic?
The four monopolistic states are Ohio, Wyoming, Washington, and North Dakota. They are called monopolistic states because they bar the sale of workers compensation insurance by private insurers. In these states, employers must buy workers comp insurance from an insurance fund operated by the state.
What is short term disability in North Dakota?
Short-Term Disability Insurance in North Dakota Short-term disability insurance, as the name implies, covers you for a limited period of time if you are unable to work as a result of an illness or accident. The duration is generally 3-6 months, although it varies based on the reason.
What is the Workers Compensation Act in North Dakota?
North Dakota's Workers' Compensation law, with limited exceptions, requires all employers to insure all employees including full-time, part-time, seasonal, and occasional workers before employees begin working. It is unlawful to deduct any portion of the premium from wages or salary of any employee.
How much does workmans comp pay in North Dakota?
Important information about benefits Wage-loss benefits are paid at a rate of 2/3s of the pre-injury gross weekly wage. The weekly benefit may not exceed the maximum benefit at the time of disability.
Who is the director of WSI in North Dakota?
Art Thompson - Director, ND Workforce Safety and Insurance - ND Workforce Safety and Insurance | LinkedIn.
Is North Dakota Workers Compensation monopolistic?
The four monopolistic states are Ohio, Wyoming, Washington, and North Dakota. They are called monopolistic states because they bar the sale of workers compensation insurance by private insurers. In these states, employers must buy workers comp insurance from an insurance fund operated by the state.
How does workmans comp work in North Dakota?
North Dakota's Workers' Compensation law, with limited exceptions, requires all employers to insure all employees including full-time, part-time, seasonal, and occasional workers before employees begin working. It is unlawful to deduct any portion of the premium from wages or salary of any employee.
How much does workmans comp pay in north dakota?
Important information about benefits Wage-loss benefits are paid at a rate of 2/3s of the pre-injury gross weekly wage. The weekly benefit may not exceed the maximum benefit at the time of disability.
How long do you have to file a workers comp claim in North Dakota?
All claims must be filed within one year after an injury or within two years after a death. The date of injury is the first date that a reasonable person knew or should have known that a work-related injury occurred.
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What is ND WSI SFN 2828?
ND WSI SFN 2828 is a form used in North Dakota for reporting wages and taxes related to workers' compensation insurance.
Who is required to file ND WSI SFN 2828?
Employers in North Dakota who are subject to workers' compensation laws are required to file ND WSI SFN 2828.
How to fill out ND WSI SFN 2828?
To fill out ND WSI SFN 2828, employers need to provide their business information, employee wage data, and any applicable deductions or contributions.
What is the purpose of ND WSI SFN 2828?
The purpose of ND WSI SFN 2828 is to report employee wages and calculate the associated workers' compensation premiums owed by employers.
What information must be reported on ND WSI SFN 2828?
The information that must be reported on ND WSI SFN 2828 includes employer details, employee names, total wages, and any deductions or contributions related to workers' compensation.
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