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DISPOSITION OF CLAIMS FORM – LOCAL CONFERENCE |
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*Union
Officer Signature |
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Organization
File No. |
Date of
Conference |
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*Carrier Officer Signature, Title, Phone No. |
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Carrier
File No. |
Location |
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*It is understood that these claims are settled
in their entirety, without prejudice to either party's contentions with
respect to the application of schedule rules. |
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Claim Ticket No. |
On-Duty/ Occurrence Date |
Claimant(s) |
Nature of Claim |
Disposition Code*
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REASON for Declination |
*Dispostion
Codes: F – Paid as claimed, P – Compromise pay, W – Withdraw, D - Denied
Send or fax (785 435-7998) this form
with a copy of the claim tickets, if available, to TYE Compensation Systems, 10th
Floor,