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Worker's Compensation Form
Click here to download the form for reporting a workers compensation claim. Once you have filled out and completed the form, email the completed form to HR@grapetree.com or fax it to (888) 678-4077.
If the state where you were injured differs from your home address, please use the following guide to determine which State FROI form to use:
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State hired = Iowa
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State you live ___________________
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State injured ___________________
Choose the state that has 2 matches above. If all 3 responses are different, then choose the state you would anticipate the majority of
medical care to occur.
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