WORKERS' COMPENSATION REQUEST FOR MILEAGE …
bills to the workers' compensation insurance carrier (or to your employer, if self-insured) and to the Workers' Compensation Board. (See Board addresses on reverse.) It is suggested that you retain a copy of the receipts and bills for your records. En relaciĆ³n con el caso de compensaciĆ³n para trabajadores antes mencionado, usted tiene ................
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