Application to Reopen Claim Due to Worsening Condition
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| 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 (115 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. The 12-2009 version has FAX numbers for Claims and for Self Insurance and is on the internet only. 8-2007 version is in the warehouse and is a current version. | |
| Detail | ||
| Form number | F242-079-000 | |
| Availability | Order it | |
| Keywords | application, application to reopen, apply to reopen, claim closure, claim information, claims, doctor, industrial insurance, injured worker, injury, insurance, occupational, occupational injuries, reopen, reopen claim, worker's compensation, workers compensation, workers' compensation, worsening | |
| Languages | English , Spanish | |
| Valid dates | 12-2009, 08-2007 | |
| Contact information |
Claims for Job Injuries
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