268. An employer bound to pay a salary or wages under section 60 shall notify the Commission that the worker is unable to carry on his employment beyond the day on which the employment injury appeared and claim in writing the amount repayable to him under that section.
The employer shall give the notification and make the claim on the form prescribed by the Commission.
The form must indicate the following particulars:(1) the worker’s name, his address, and his social insurance and health insurance numbers;
(2) the name and address of the employer and of his establishment as well as the number assigned to each of them by the Commission;
(3) the date of the beginning of the worker’s disability or the date of his death;
(4) the place and circumstances of the industrial accident, where that is the case;
(5) the gross income described in the worker’s contract of employment;
(6) the amount payable under section 60;
(7) the name and address of the health professional designated by the employer to receive communication of the medical record kept by the Commission on the worker; and
(8) if the employer contests the fact that there is an employment injury or the foreseeable date or time of consolidating of the injury, the grounds for his contestation.