Declaración de Derechos para los Beneficios de un Trabajador Totalmente Discapacitado Bajo las Leyes del Seguro Industrial

Declaración de Derechos para los Beneficios de un Trabajador Totalmente Discapacitado Bajo las Leyes del Seguro Industrial - (Forms/Publications)
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Title   Declaración de Derechos para los Beneficios de un Trabajador Totalmente Discapacitado Bajo las Leyes del Seguro Industrial (143 KB PDF)
Description

Used by a totally permanently disabled worker. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits.

Detail
Form number F242-173-944
Availability
Online only. See document above to download.
Keywords claim information, claims, coverage, declaration, disability pension benefits, entitlement, industrial insurance, injured worker, injuries, injury, insurance, occupational injuries, pension disability benefits, social security offset, sso, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 11-2009
Contact information
Web pages Workers' Comp Claims

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