Organization Type Valid Values 'I' - Insurance Carrier 'E' - Employer 'L' - Lien Claimant Earnings Type Valid Values 'M' - Monthly 'W' - Weekly 'H' - Hourly Application for Adjudication Information from the cover sheet. Injured worker's name and address -- required If the applicant is NOT the injured worker complete this section. Coversheet information DOB of injured worker Injured worker's occupation at time of injury M - Monthly, W - Weekly, H - Hourly M - Monthly, W - Weekly, H - Hourly I - Insured, S - Self-Insured, L -Legally Uninsured, U - Uninsured Address of the injured worker I - Insurance Carrier, E - Employer, L -Lien Claimant Limited to 40 characters