Toll Free Number Toll-Free 1-800-745-9970 | Chat Live Chat
Top 5 reasons why you should choose LaborLawCenter™.
Free UPS Ground Shipping on all orders over $50.
Ordering can be done online, by phone, fax or mail.
Stay current with the most up-to-date information by subscribing to the LaborLawCenter™ newsletter!

Alaska Petition to Join Second Injury Fund and Claim for Reimbursement Form (07-6109)

SKU: FFAK115 | 
This product is offered FREE from LaborLawCenter™
Reminder: After you have selected your free form(s) and added it to your cart, you are to complete the checkout process. You will not be charged for the form(s). Upon completion of the checkout process, you will be sent an email with a link to download your free form(s). For more information click here.
Product Description

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.

LaborLawCenter™ stands behind
our products through our 365-Day
Satisfaction Guarantee. For
assistance, contact us
at 800-745-9970.

Connect with LaborLawCenter™ on
Facebook, Twitter, LinkedIn & Google+
McAfee Secure sites help keep you safe from identity theft,
                                                 credit card fraud, spyware, spam, viruses and online scams 90 Days Shipping Work Green