Authorization to Release Claim Information


Authorization to Release Claim Information

Document Information
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Title	Authorization to Release Claim Information (A fillable form - 153 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	F101-010-000
Availability	Order it
Keywords	authorization, authorized representative, claim information, claims, designee, espanol, industrial insurance, insurance, release information, representative, spanish, worker's compensation, workers compensation, workers' compensation
Languages	English , Spanish
Valid dates	04-2006
Contact information	Managing Injured Workers' Claims Claims for Job Injuries
Web pages	Workers' Comp Claims