Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores


Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores

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Title	Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores (108 KB PDF)
Description	Used by a totally permanently disabled worker. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits.
Detail
Form number	F242-173-944
Availability	Online only
Keywords	benefits, claim information, claims, coverage, declaration, disability, disability & pension benefits, disability and pension benefits, disability benefits, disability pension benefits, disabled, entitlement, industrial insurance, injured worker, injuries, injury, insurance, occupation, occupational, occupational injuries, offset, pension, pension & disability benefits, pension and disability benefits, pension benefits, pension disability benefits, security, social, social security, social security offset, sso, worker, worker's compensation, workers compensation, workers' compensation
Languages	Spanish , English
Valid dates	10-2008
Contact information	Managing Injured Workers' Claims Claims for Job Injuries
Web pages	Workers' Comp Claims