Application for Group Retrospective Rating
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
Application for Group Retrospective Rating (A fillable form - 276 KB PDF)
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|
| Description | Used by organizations to set up an agreement with L&I authorizing their participation in retrospective rating. | |
| Detail | ||
| Form number | F250-004-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | industrial insurance, reducing premiums, retro, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 04-2012 , Mo-2011 | |
| Contact information |
Contact Us About Retrospective Rating
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| Related information | ||
| Documents | Application for Group Membership & Authorization for Release of Insurance Data |
|
| Web pages | Qualify for Refunds | |
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