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Ohio Application for Handicap Reimbursement (CHP-4A)
SKU: FFOH195 |   E-mail this product to a friend
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Product Description

Employers use this form to request that a percentage of the costs in an employee's workers' compensation claim be charged to, or refunded from, the Statutory Surplus Fund. They must provide evidence that the injury, disease or death would not have happened if not for the employee's pre-existing handicap condition or the aggravation of a pre-existing handicap condition. The form includes a schedule of the qualifying handicap conditions.
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