Autorización para Proveer Información de Reclamos

Autorización para Proveer Información de Reclamos - (Forms/Publications)
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Title Autorización para Proveer Información de Reclamos (A fillable form - 154 KB PDF)
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.

Detail
Form number F101-010-999
Availability
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Keywords authorization, claims, designee, espanol, industrial insurance, release information, representative, spanish, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 04-2006
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Web pages Workers' Comp Claims

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