Authorization to Release Claim Information

Document Information
  How to complete a fillable form.
Title Authorization to Release Claim Information

Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information.

Document number F101-010-000
How to get this document
  • Order it from our Warehouse
  • Alt Language(s) Español
    Valid dates 03/2014
    Contact information Claims for Job Injuries , Managing Injured Workers' Claims
    Websites Workers' Comp Claims

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