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Lump Sum Or Advance Payment Essay

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Utah Application for Lump Sum or Advance Payment Form Form 134 Application for Lump Sum or Advance Payment is an instrument to request an administrative law judge to pass an order to release the payment in advance under special conditions like an injury at work. Administrative law judge is authorized to pass the order to the Employer and/or Workers’ Compensation Insurance Company under the Section 34A-2-421, U.C.A. Please read this document carefully before proceeding and provide all particulars truthfully. Your signature on the form is mandatory in acknowledgement of the particulars furnished in the Form 134. Specify the amount requested and the reason for it in detail in the spaces provided for the same as the information furnished is decisive…show more content…
Commence by printing employee name, date of injury, and then print the employer name. You may choose to furnish name of Workers’ Compensation Insurance Company instead of the Employer if applicable. Proceed to Section 1 and select if you are currently employed and no otherwise. Provide Employer name and monthly earnings in US dollar on the subsequent lines if you select yes. Specify your engagement in vocational rehabilitation program by selecting yes or no. Provide the name of the rehabilitation counselor on the next line if your response is yes in section 2 of Form 134. Section 3 requires information about the employment status of your spouse. Record appropriate response and specify name of the spouse’s employer if your response is yes. Specify the number of children under age 18 in Section 4. Furnish your monthly liabilities towards living. Provide detailed description of various expense heads and liability in amount towards it. Add the value of all obligations to arrive to total obligation for each month. Use separate sheet if needed. Specify if you or your spouse receive monthly benefits of any sort in Section
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