Authorization to Release Claim Information

Document Information
  How to complete a fillable form.
Title Authorization to Release Claim Information

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, Managing Injured Workers' Claims
Websites Workers' Comp Claims

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