Declaración De Derechos Para Viuda(O) Bajo El Programa De Compensación Y Beneficios Para Trabajadores


Declaración De Derechos Para Viuda(O) Bajo El Programa De Compensación Y Beneficios Para Trabajadores

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Title	Declaración De Derechos Para Viuda(O) Bajo El Programa De Compensación Y Beneficios Para Trabajadores (117 KB PDF)
Description	Used by the widow/widower whose spouse died of a work related injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of your benefits.
Detail
Form number	F242-173-911
Availability	Online only
Keywords	benefits, claim information, claims, coverage, deceased, deceased worker, declaration, disability, disability & pension benefits, disability and pension benefits, disability benefits, disability pension benefits, disabled, entitlement, industrial insurance, insurance, occupation, occupational, occupational death, offset, pension, pension & disability benefits, pension and disability benefits, pension benefits, pension disability benefits, security, social, social security, social security offset, sso, surviving spouse, survivor benefits, survivors, worker, worker's compensation, workers compensation, workers' compensation
Languages	Spanish , English
Valid dates	10-2008
Contact information	Managing Injured Workers' Claims
Web pages	Workers' Comp Claims