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» UR-C Request » Claim
Claim
If you do not know the claim number, use
Claim Lookup
Claim Number
Claim Lookup
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Claim Lookup
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A claim number.
Employee's SSN and Injury Date
Last Name, First Name, and Injury Date
Last Name, Employee's Date of Birth, and Injury Date
Claim Number
Employee's SSN:
Employee's Last Name
Employee's First Name:
Employee's DOB
Injury Date
First Name
Last Name
Date of Injury
Employer
Claim Number
Claim Status
Body Part
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