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			<SubmitDate>2024-04-04</SubmitDate>
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		<EventCode code="RFA-1LC">
			<TransactionSequenceNumber>12923432934</TransactionSequenceNumber>
			<WCBCaseID>12345678</WCBCaseID>
			<DateOfInjury>
				<DoiMonth>03</DoiMonth>
				<DoiDay>18</DoiDay>
				<DoiYear>1991</DoiYear>
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			<AttestationConfirmationCode>Y</AttestationConfirmationCode>
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						<UploadHealthCareProviderName>Anna Wintour PA</UploadHealthCareProviderName>
						<UploadServiceDate>2000-02-24</UploadServiceDate>
						<UploadFileSize>1283</UploadFileSize>
						<UploadDocumentDescription>MMI for patient for case</UploadDocumentDescription>
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				<EstablishAWWConcurrentEmployment>N</EstablishAWWConcurrentEmployment>

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								<AwardPeriodAwardIndicator>Y</AwardPeriodAwardIndicator>
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				<AdditionalProposedFindingAttorneyFeeReq>Y</AdditionalProposedFindingAttorneyFeeReq>

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