Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance

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Título Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance (Un formulario electrónico)- 137 KB PDF)
Descripción 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.
Detalle
Número del formulario F242-173-444
Disponibilidad solicítelo
Palabras claves claim information, claims, coverage, disability pension benefits, espanol, injured worker, injury, insurance, occupational injuries, pension disability benefits, social security offset, spanish, sso, worker's compensation, workers compensation, workers' compensation
Idiomas English, Spanish
Fechas válidas 11-2009
Contacto
Páginas de Internet Workers' Comp Claims

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