Time of Loss * -Select Time of Loss- 12:00 AM 12:15 AM 12:30 AM 12:45 AM 01:00 AM 01:15 AM 01:30 AM 01:45 AM 02:00 AM 02:15 AM 02:30 AM 02:45 AM 03:00 AM 03:15 AM 03:30 AM 03:45 AM 04:00 AM 04:15 AM 04:30 AM 04:45 AM 05:00 AM 05:15 AM 05:30 AM 05:45 AM 06:00 AM 06:15 AM 06:30 AM 06:45 AM 07:00 AM 07:15 AM 07:30 AM 07:45 AM 08:00 AM 08:15 AM 08:30 AM 08:45 AM 09:00 AM 09:15 AM 09:30 AM 09:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM 11:00 AM 11:15 AM 11:30 AM 11:45 AM 12:00 PM 12:15 PM 12:30 PM 12:45 PM 01:00 PM 01:15 PM 01:30 PM 01:45 PM 02:00 PM 02:15 PM 02:30 PM 02:45 PM 03:00 PM 03:15 PM 03:30 PM 03:45 PM 04:00 PM 04:15 PM 04:30 PM 04:45 PM 05:00 PM 05:15 PM 05:30 PM 05:45 PM 06:00 PM 06:15 PM 06:30 PM 06:45 PM 07:00 PM 07:15 PM 07:30 PM 07:45 PM 08:00 PM 08:15 PM 08:30 PM 08:45 PM 09:00 PM 09:15 PM 09:30 PM 09:45 PM 10:00 PM 10:15 PM 10:30 PM 10:45 PM 11:00 PM 11:15 PM 11:30 PM 11:45 PM
Highly recommended: When prompted, provide an email address for your injured worker if available. This allows us to streamline our communication so the injured worker is as informed as possible throughout the process.
