Request for Claim Information
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
Request for Claim Information (A fillable form - 150 KB PDF)
|
|
| Description | Used by workers, workers' representatives, employers or employers' representatives to request claim information from L&I. | |
| Detail | ||
| Form number | F101-010-111 | |
| Availability | Online only. See document above to download. |
|
| Keywords | claims, file, industrial insurance, most requested forms, release information, self insurance, self insurer, self-insurance, self-insurer, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 02-2000 | |
| Contact information |
Managing Injured Workers' Claims
Claims for Job Injuries Self-Insurance |
|
| Web pages | Workers' Comp Claims | |
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