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  1. #1
    Join Date
    Dec 2012
    Posts
    59

    Default I Have Received a WC Number, but I Never Filled Out the Pink Form

    My workers compensation claim was made in the State of: Arizona

    I have had contact with WC insurance adjuster and received a WC number and script card. I never filled out a pink form when I went to doctor after work injury. Do I still need to fill out the form? I told my employer within a hour of injury and went to my family doctor the day of injury, but my dr does not participate in workers comp. So I went to a doctor I had seen for prior low back pain. I didn't fill out any injury form with that doctor either.

    What should I do?
    Thank you in advance for your advise.

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    17,938

    Default Re: I Have Received a WC Number, but I Never Fill Out Pink Form

    Contact the CA/Claims Adjuster and find out what forms are necessary.

  3. #3
    Join Date
    Dec 2012
    Posts
    59

    Default Re: I Have Received a WC Number, but I Never Fill Out Pink Form

    My doctor has been in contact with the insurance adjuster and I was approved for a MRI which I have completed. Why would I need to fill out the form if I already have WC# and adjuster and WC personel at my doctors office has been in contact with WC adjuster? I have not been able to get a clear reply from the adjuster regarding the 102(pink form). I was also sent a paper for all medical records to be released, which I did sign.

    Also my contract has expired with the company I was working for at the time of injury. Will I still be able to receive benefits even though I no longer have employment with the company I was injuried at? I am not a self employed contractor. The insurance adjuster is from Galleger Bassett.

    Does anyone have a idea how long it takes to receive WC payments in AZ?

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