Obtenga un formulario o publicación: adjustments
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| Título | Tipo | Número |
|---|---|---|
Providers Request for Adjustment Providers use this to report total overpayment, partial overpayment and/or underpayment by L&I. These forms will be accepted by L&I. They may not be accepted by all Medical Bill Processors due to lack of a barcode. |
Form | F245-183-000 |
| Social Security Offset Calculations Only Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers
Used by self-insured employers to request reimbursement from L&I for cost-of-living-adjustments paid to injured workers. |
Form | F207-011-222 |
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