Retrospective Rating Adjustment Protest

Retrospective Rating Adjustment Protest - (Forms/Publications)
Document Information
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Title Retrospective Rating Adjustment Protest (141 KB DOC)
Description

Used by employers to present L&I with a list of decisions they are protesting by adjustment period. The form requests all necessary elements needed for L&I to process a request for reconsideration.

Detail
Form number F250-024-000
Availability
Online only. See document above to download.
Keywords adjustment protest, assessment, coverage year, premium refund, request for reconsideration, retro, retrospective rating
Languages English
Valid dates 04-2013
Contact information Contact Us About Retrospective Rating
Web pages Qualify for Refunds

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