Application For Discretionary Payments From The Uninsured Employers Fund {DWC-UEF 50}

DWC-UEF 50, APPLICATION FOR DISCRETIONARY PAYMENTS FROM THE UNINSURED EMPLOYERS' FUND. This form is used in the state of California for employees who have been injured or become ill as a result of work, but whose employer did not have workers' compensation insurance coverage. The Uninsured Employers' Fund (UEF) is a program administered by the California Division of Workers' Compensation that provides benefits to employees who are injured while working for an employer who was not insured for workers' compensation. The UEF is funded by penalties and assessments levied against employers who fail to carry workers' compensation insurance. The DWC-UEF 50 form is used to apply for discretionary payments from the UEF when an employer fails to provide workers' compensation benefits. The form requires the employee to provide information about their employer, the date and circumstances of the injury or illness, and any medical treatment or expenses incurred as a result of the injury or illness. The UEF has the discretion to provide benefits to injured workers in cases where their employer did not have workers' compensation insurance coverage. However, discretionary payments are not guaranteed and are only provided in certain circumstances. The UEF may also seek reimbursement from the employer for any benefits paid to the employee. Rev: 11/2008. www.FormsWorkflow.com