Cc-Form-4 - Report Of Compensation Paid - Oklahoma Workers' Compensation Commission Page 2

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CC-FORM-4
(Report of Payment)
Questions about the CC-Form-4, or general information or assistance on completing or
filing a CC-Form-4, may be directed to the Workers’ Compensation Commission
Counselor Division, (405) 522-5308 or In-State Toll Free (855) 291-3612.
Administrative Workers’ Compensation Act, 85A O.S., §6(A)(1)(a): “Any person or entity who makes any
material false statement or representation, who willfully and knowingly omits or conceals any material
information, or who employs any device, scheme, or artifice, or who aids and abets any person for the
purpose of: (1) obtaining any benefit or payment … shall be guilty of a felony.”
Any person who commits workers’ compensation fraud, upon conviction, shall be guilty of a felony
punishable by imprisonment, a fine or both.

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