Pre-paid Debit Card Enrollment Application (A-21)
Introduction
Injured workers receiving permanent total disability benefits can have their benefit payments loaded onto a prepaid debit card after receiving and reading through all pre-acquisition disclosures. With the prepaid debit card, injured workers will have funds to make purchases, get cash, and pay bills anywhere Visa® is accepted. Funds on the prepaid Visa® debit card are protected if the card is lost or stolen.
BWC will automatically deposit your benefits directly onto your prepaid debit card. Injured workers can make purchases, get cash, and pay bills anywhere Visa® is accepted. Funds on the prepaid Visa® debit card are protected if the card is lost or stolen.
- You are generally protected from all liability for unauthorized transactions with Zero Liability. You must call the number on the back of your Card immediately to report any unauthorized use. Certain conditions and limitations may apply. See your Cardholder Agreement for details.
The ReliaCard® is issued by U.S. Bank National Association pursuant to a license from Visa U.S.A Inc. © 2022 U.S. Bank. Member FDIC.
Required information
- Electronic signature on the pre-paid debit card agreement
If you have all the required information on hand, simply click the start button to begin.