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WI1COMPSTAT
Status of worker's compensation claim for 1st injury

Survey Text

1988
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1988
Survey form view entire document:  text  image
If Yes in question 17b, page 54/55, ask:
1. Was the worker's compensation claim for your injury on (date in 3, page 52/53) awarded, denied, or is it still in process?

[] Injury 1
1[] Awarded
2[] Denied
3[] In process
9[] DK