Authorization to Release Claim Information


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Title Authorization to Release Claim Information
Description

Used by the worker to designate a person(s) as an authorized representative for the worker's claim. An authorized representative can access claim information.

Document number F101-010-000
How to get this document
Alt Language(s) Español
Valid dates 03/2014
Contact information Claims for Job Injuries, Employer Services
Websites Workers' Comp Claims

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