Retrospective Rating Adjustment Protest
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Retrospective Rating Adjustment Protest (141 KB DOC)
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| 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. |
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| Detail | ||
| Form number | F250-024-000 | |
| Availability | Online only. See document above to download. |
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| 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
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| Web pages | Qualify for Refunds | |
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