Occupational Disease Claim
You may be entitled to benefits if you have been diagnosed with a condition, illness, or disease that you or your doctor believe is caused by a past exposure to a health hazard at work.
To submit an occupational disease claim:
- Submit a Worker’s Report of Occupational Disease (Form 6S).
- Please provide as much detail as possible including:
- Medical information
- Diagnosis or medical condition for which you are making the claim.
- Doctor’s contact information, dates of your visits and any medical tests completed.
- Exposure to hazardous substances
- Employer’s contact information and dates of employment.
- Type of work you performed and a description of your duties.
- Hazardous substances to which you believe you were exposed.
If you would like for us to discuss your claim with your spouse, family member or other representative (such as a friend or union representative), please complete section G of the Form 6 or the Authorized Representative Consent (Form 13).