Voices from the Field

From RECP Form, 2021

Part 11: PREVIOUS PAYMENTS OF MONEY.

Please answer the following question:

Have you or anyone else received any payment of money pursuant to final award or settlement on a claim (other than a claim for worker’s compensation) against any person (or corporation), that is based on the illness for which this claim is submitted?

YES [ ] NO [ ]

If you checked "YES," please use a separate sheet of paper to identify the date, amount, and person or organization from whom EACH AND EVERY payment of money was received, and explain the circumstances surrounding the payment.
 

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