California Event Matrix

55 Number of Dependents If Date of Death provided, then Mandatory. 56 Date Disability Began 57 Employee Date of Death Mandatory if injured worker died. 68 Date of Return to Work Employment 58 Employment Status Code 59 Class Code If (MTC=00, AU, 04, 02, CO or UR) AND Self Insured Indicator (DN24)=N, then Mandatory. ................
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