Application to Reopen Claim Due to Worsening Condition
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Application to Reopen Claim Due to Worsening Condition (124 KB PDF)
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| Description | Used by injured workers and doctors to apply to reopen an industrial injury or occupational disease claim that has been closed for longer than 60 days. 12-2009 version is in the warehouse until stock is used up, then the new 12-2012 version will be printed. |
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| Detail | ||
| Form number | F242-079-000 | |
| Availability | Order it |
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| Keywords | claim information, industrial insurance, occupational injuries, reopen, reopen claim, Reopening, worker's compensation, workers compensation | |
| Languages | English , English/Spanish , Spanish | |
| Valid dates | 12-2012 | |
| Contact information |
Claims for Job Injuries
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