Application to Reopen Claim Due to Worsening Condition

Application to Reopen Claim Due to Worsening Condition - (Forms/Publications)
Document Information
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Title Application to Reopen Claim Due to Worsening Condition (A fillable form - 216 KB PDF)
Description

This application is by injured workers and providers to apply to reopen an industrial injury or occupational disease claim due to worsening condition for claims that have been claims 60 days or longer.

Detail
Form number F242-079-000
Availability
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Keywords claim information, industrial insurance, occupational injuries, reopen, reopen claim, Reopening, worker's compensation, workers compensation
Languages English , English/Spanish , Spanish
Valid dates 03-2014
Contact information Claims for Job Injuries

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