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Alaska Petition to Join Second Injury Fund and Claim for Reimbursement Form (07-6109)
SKU: FFAK115 | 
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This form should be filed only after the employer or the insurer has submitted a Notice of Possible Claim Against the Second Injury Fund (AWCB form 07-6110) and has paid at least 104 weeks in compensation payments. Since regulation 8 AAC 45.186(f) does not allow the Second Injury Fund to make lump-sum reimbursements, reimbursement for compensation between 104 weeks and the filing date of this petition will be made on a monthly basis. Second Injury Fund reimbursements are for disability payments only; attorney fees, medical payments and 041(k) wages will not be reimbursed. Payment will be at the claimant’s weekly compensation rate.


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