Application for L.E.P. Compensation Medical

Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Application for L.E.P. Compensation Medical

Completion of this form is not a guarantee of benefits. Payment of benefits will be decided by your claim manager.

Document number F242-208-000
How to get this document
Keywords claims, compensation, L.E.P., medical
Alt Language(s) English/Español , Español
Valid dates 12/2004
Contact information Claims for Job Injuries

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.