Obtenga un formulario o publicación: partial
Su búsqueda de "partial" consiguió 20 resultados.
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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 |
| Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment
This worksheet is to help the attending physician perform impairment rating on their patients with permanent partial disability of the Dorso-Lumbar or Lumbo-Sacral spine. |
Form | F252-006-000 |
| Is Retrospective Rating Right for You?
Pamphlet: Provides information about L&I's Retrospective Rating Program. In Retro, employers can earn a partial refund of workers' compensation premiums if they reduce workplace injuries and lower associated claim costs. |
Publication | F250-006-000 |
| Notificaci贸n de Decisi贸n de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-NTL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-999 |
| Notificaci贸n de Decisi贸n de Cierre con Discapacidad Parcial Permanente para Empleadores Autoasegurados - PPD-TL
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-999 |
| Notificaci贸n de Decisi贸n de Cierre para reclamos de Tiempo Perdido para Empleadores Autoasegurados
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-999 |
| Notificaci贸n de Decisi贸n de Cierre para reclamos 脷nicamente M茅dicos para Empleadores Autoasegurados
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-999 |
| Schedule of Future Payments for the Balance of the Permanent Partial Disability Award
Schedule of Future Payments for the Balance of the Permanent Partial Disability Award. |
Form | F207-162-000 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-111 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Cambodian
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-666 |
| Self-Insured Employers' Medical Only Claim Closure Order and Notice - Korean
Also available in: English Used by self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed with medical benefits only. This order is used only when neither time loss compensation nor a permanent partial disability award has been paid. |
Form | F207-020-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL - Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-777 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL -Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has not been paid, but a permanent partial disability award is being paid. |
Form | F207-165-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL
Also available in: Cambodian, Korean, Spanish Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-000 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL - Cambodian
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-666 |
| Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL -Korean
Also available in: English Used by self-insured employers or their representatives only, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, and a permanent partial disability award is also being paid. |
Form | F207-164-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice
Also available in: Cambodian, Korean, Spanish Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-000 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice - Korean
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-777 |
| Self-Insured Employers' Time Loss Claim Closure Order and Notice -Cambodian
Also available in: English Used by only self-insured employers or their representatives, this is legal notification to an injured worker that their claim is being closed. This order is used only when time loss compensation has been paid, but no permanent partial disability award is being paid. |
Form | F207-070-666 |
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