Last updated: 10/25/2024
Penalty Request
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Description
PENALTY REQUEST -- WORKERS' COMPENSATION. This form from the Minnesota Department of Labor and Industry is used by employees, employers, insurers, or third-party administrators to report and request penalties for various violations under Minnesota’s Workers' Compensation laws. The form addresses common issues such as late payments of wage replacement benefits (like temporary or permanent disability payments), late payments of medical bills, and delayed responses to rehabilitation invoices. Each type of penalty has specific documentation requirements, such as copies of checks, payment stubs, or postmarked envelopes, which must be submitted to support the penalty request. This form facilitates compliance monitoring by enabling the Department to review and potentially assess penalties for delayed or improperly handled workers' compensation benefits. www.FormsWorkflow.com
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