1. A. After payment of all compensation the employer’s representative shall file with the Commission’s Claims Department a Form 19, Status Report and Compensation Receipt, as provided in Section C below. If an individual claim file has been created by the Commission, a Form 19 is required to close the file, even if no compensation has been paid.

2. B. When the employer’s representative denies the claim, a Form 19 must be filed with the Claims Department, and the employer’s representative shall:

   1. (1) Attach to the form a copy of the letter provided to the claimant denying the claim; and
   2. (2) Complete, sign, and file a Form 19. The claimant’s signature is not necessary.

3. C. In all other cases, complete and file a Form 19 as provided below:

   1. (1) When more than one person receives payment of compensation, prepare a separate Form 19 for each person or Guardian and a final, additional Form 19 indicating the total amount of compensation paid and all medical expenses incurred in the claim.
   2. (2) Complete each line indicating payment of temporary total (TT), temporary partial (TP), and permanent partial (PP) compensation, disfigurement, and final release (an Agreement and Final Release), if applicable.
   3. (3) The claimant’s signature is required on the Form 19 when permanent disability, disfigurement, or death benefits are paid or when the claim is settled by a Full and Final Release. The preparer shall sign and date the Form 19.
   4. (4) File the completed Form 19 with the Claims Department.

HISTORY: Amended by State Register Volume 19, Issue No. 5, eff May 26, 1995; State Register Volume 20, Issue No. 5, eff May 24, 1996; State Register Volume 21, Issue No. 4, eff April 25, 1997.